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C41se Ao. ME Dececent: tAilm LAST yo/t FIRST ai/3 0/r ‘ WOOLS A medical report on the death of D. W. wrote, “it is clear that he was not currently under any special watches or treatments. There were no documented orders that I found to keep a closer watch or have greater precautions than normal at the time of this incident. According to the staff on duty at the time this occurred, there was no indication from D.W. of what was about to happen. Although D.W. was said to be exhibiting violent behavior and was ‘punching the walls,’ no one reported any suicidal indications by D.W. “It appears at this time that given the circumstances at the time of this suicide, there was nothing that could have been done to prevent that act from occurring. It happened within a very short time period.” except years old. What can you say? What can anyone say except that it’s not true. Buried in the nurse’s log is a summary of D.W.’s behavior, on morning shift, apparently the day before the suicide: “Threatened peers, threatened to hurt self, tried to strangle self with a belt. Patient has been telling staff he wants to kill himself. Not put on precautions yet.” If no one knew he was contemplating suicide on the fatal day, it may be because no one had read the previous day’s nursing notes. In fact, on the night shift after he threatened his own life, complacency had already set in among the staff about the cause of D.W.’s suicidal threats: “Wanted attention” was noted. Perhaps Detective Gilchrest needed to dig a little deeper. “I put him there to be safe,” his mother sighs, although even she has no illusions about her son’s difficulties. In his hometown, north of Austin, the boy had threatened a few months earlier to jump off a three-story building. He had already been in trouble with the police and been placed on probation. He had also cut himself during his stay at the State Hospital. That time he was put on “precautions.” His mother recalls going to see her son and walking into the visitation area, and D.W. entering a little while later with a staff member following at his heels. He was on “one-to-one” a suicide watch precautions. Why wasn’t he, his mother asks, put on precautions this time? The Department of Mental Health and Mental Retardation is keeping most of the file on the case closed to public scrutiny. But even without reviewing the file, there is one obvious potential explanation: the State of Texas ranks forty-third in the country in spending on mental health. In most states, this statistic would be a cause for concern, but in Texas’s limited-government environment, it’s more often a source of pride. One result of these conservative economics has been a continuing labor shortage at the Texas Department of Mental Health and Mental Retardation, with low pay and poor working conditions cited most often as reason for resignations and call-ins. \(The nurse on duty when D.W. died, for example, was from a temporary agency: he has been a “temporary” at the Austin State Hospital for age, one-to-ones and suicide watches are reluctant last steps, because they require taking a mental health worker off the floor, where he can watch four or five patients, and assigning him to follow only a single patient, one-to-one. There’s more. The results of the toxicology examination on D.W.’s blood found no Ativan in his system. Either the toxicology results are incorrect, or D.W. “cheeked” the medication, a popular trick in mental health facilities: a patient pretends to swallow a pill but spits it out when the nurse isn’t looking. If D.W. did succeed in cheeking the Ativan, the hospital staff deserves some blame. But questioning the staff’s performance is the easy way out. To find out the truth about how this child died, Detective Gilchrest really needed to begin his investigation at the Capitol. The questioning should have begun with legislators and Governor Bush. During the last legislative session, the Department of Mental Health and Mental Retardation requested a $576 million increase in funding. Governor Bush recommended an increase of $43 million. The Legislature provided $169 million. Together the Governor and legislators have tried to make state government run “more like private business,” but in that attempt they have forgotten the first rule of any commerce, public or private: you get what you pay for. “Upset because a girl from `13′ broke up with him. Broke a pen and used the ink to paint on his face. Sat on the stall doors in the bathroom and wouldn’t get down. Repeated acting out for attention. Sent back from school for kicking furniture and threatening to run away. Multiple personal holds.” That was part of the last day shift’s report. On evening shift, the state’s file on D.W. was finally closed: “Patient went into the restroom and hung himself. Staff and E.M.S. tried to revive to no avail. Patient expired. DECEASED.” Maybe more staff and precautions wouldn’t have helped in this case. Basically this child had been threatening to commit suicide since he was seven years old. But one thing is certain. The State of Texas took charge of his care, and he finally succeeded. [2] Austin writer Lucius Lomax contributes frequently to the Observer on state agency affairs. THE TEXAS OBSERVER 15 MAY 26, 2000