Wednesday, May 6, 1998
It's hot outside when Stan Israel arrives at his Lakewood apartment. He takes off his shoes, sits down, turns on the TV and unwinds. He calls his girlfriend, Patricia, and they make a dinner date. She loves to cook, so later on he'll drive over to her place in south Denver.
Then he notices a face looking through his window. Still on the phone, he gets up to see who it is just as there's a knock on the door. He goes to the door and finds himself staring at two Lakewood police officers. One is a short and stocky woman, the other a beefy man.
Is his name Stanley Israel? one of them asks.
Yes, Israel replies.
They ask if they can come in.
He lets them in and tells Patricia he'll call her back.
The officers ask if everything is okay.
"Yes, why?" he responds. They ask if he has been drinking that day. He tells them no, he just got home from work. They look around, ask him for ID. He shows them his driver's license.
The officers look cautious, and he can tell they're looking past him and inspecting the room. Earlier that day, they tell him, someone made a call to Lutheran Medical Center in nearby Wheat Ridge and reported that Israel had been drinking heavily and brandishing a weapon. He hadn't been taking his medication, the caller said, and was suicidal.
Israel thinks maybe a friend is playing a prank on him. He tells the cops he's not on medication and hasn't been drinking. While he does own a .25 pistol, he keeps it hidden away.
The female officer radioes her dispatcher and says that Israel is coherent and everything seems fine. She writes in her report that he is not intoxicated. The cops ask if Israel will come with them to Lutheran and get this straightened out. It'll only take an hour.
Had Israel said, "No, thank you," the cops--with no reason to detain him--might have gotten in their car and driven off, and Israel would have gone over to Patricia's for dinner.
Instead, Israel tells the police he'll come with them. Their visit is a simple mixup, he figures. He phones Patricia and tells her he'll be late. He wants to drive his own car to the hospital, but the officers say they'd prefer he ride with them. They offer to give him a lift back home when everything has been cleared up.
After he is frisked for weapons, he jumps in back and the squad car heads to Lutheran.
Stan Israel is escorted through the emergency room at Lutheran Medical Center. The cops drop him off with a nurse who appears to be expecting him. He's led to an exam room. Ten or fifteen minutes pass. Israel sits there alone. He's calm, thinking about dinner with Patricia.
A male nurse enters and asks him to remove his clothes and put on a hospital gown. Israel tells him he is just there to talk, not to be treated. The nurse insists. So does Israel. A twinge of doubt enters Israel's mind. He knows something is wrong but reaches a compromise with the nurse. Israel will change if the nurse will find someone who can get this sorted out. Israel's clothes go into a bag, and the nurse takes them away.
Twenty minutes later, the same nurse returns and takes Israel's vital signs. The nurse tells him what he's found out, which is what Israel already knows: Someone claims he's been drinking, waving a weapon and acting suicidal. And that he has a history of being a manic depressive. Israel says it's not true--all day long he's been at his job installing sensors for residential electric meters at Tru-Check, which works out of the Public Service Company of Colorado building in northeast Denver.
The nurse needs to draw blood and take a urine sample. Israel agrees, figuring two negative results will get him off the hook. Israel goes back through the last couple of days but can think of nothing that would explain the mess he finds himself in. He asks if he can use a phone. No one lets him.
Dr. Kelli Lewis, an emergency-room doctor, enters Israel's room. Israel explains his situation and points out that he volunteered to come down; now it's like he's done something wrong.
Lewis tells him that if he had not come voluntarily, he would have been brought anyway. Maybe I'll just knock you out and leave, Israel thinks to himself, a little angry--but he knows better than to mouth off now.
Lewis fills him in on the details. It was his sister, J.J. Beumer, who called the hospital and reported that Israel had been drinking, had waved his gun at his own daughter and her son, had a history of bipolar disorder and had been suicidal. Israel tells Lewis the claims are ridiculous. He doesn't even know what bipolar disorder is, he says. He tells her he owns a gun because his house was once burglarized.
Does he get depressed? Lewis asks.
Israel says he gets down around Christmastime because he can't see his daughter. But he just spends a few days on the couch, alone, thinking, "This sucks," and then his mood lifts.
He is dumbfounded by the news that his sister called. After all, he explains to Lewis, he was just at her place two days earlier, babysitting his niece while J.J. was out grocery shopping, and then later, when she went to pick up Israel's nephew from school.
Lewis asks Israel about his gun. Israel says that after his apartment was burglarized a few years ago, he bought the gun for $50 at a pawnshop. He says he never takes it out.
The hospital is running the blood and urine tests. If Lewis feels Israel won't harm himself or anyone else, she'll let him go--that's another reason to remain calm, Israel thinks. If not, he'll be forced to stay. If he tries to leave, they will restrain him.
Israel is scared. He asks to use the phone to cancel his dinner date. Lewis says she'll arrange it, then leaves. He doesn't get to make the call.
A new nurse enters with paperwork for him to sign. The form states that Israel will pay for the tests and treatment he's receiving. But Israel's health insurance at work hasn't kicked in yet. "I'm not signing this," he tells the nurse. "I'm here involuntarily."
"It's just standard procedure," the nurse says.
Israel's resolve holds. "No, I don't think so."
A counselor from West Pines, the behavioral health center at Lutheran, enters to ask Israel some questions. She asks if he knows what day it is, where he is, and who the president of the United States is. She asks about his family.
The family is not close. His mom, Israel says, has been addicted to Valium for as long as he can remember. They don't get along, and he's spoken to her only twice in the last few years. His dad was a compulsive gambler. Of all his family, he is closest to J.J. He says he's never been treated for mental illness or had medication prescribed. Yes, he was down during the holidays, and yes, he does have a few beers and play some pool with his friends at the end of the week, but he's not crazy, and he's no alcoholic.
The counselor has also talked to Israel's ex-wife, Karen Barrett, who says she thinks he may be depressed. Israel says they've been divorced for ten years; she doesn't know his personal life at all.
Still, he passes up a chance to give the counselor the names of friends who can vouch for his character--he's embarrassed and doesn't want to bring them into this. He keeps quiet, but in the back of his mind he's thinking about "getting on someone's legal ass" when this is over. The counselor asks him if he wants some food. He says he'll wait. He thinks he'll get out of here sooner rather than later.
The West Pines report finds that Israel exhibits certain manic/hypomanic symptoms--irritability, racing thoughts, distractibility and impulsivity--and that he is suicidal and has homicidal thoughts about his ex-wife. According to the report, his posture is tense, his facial expression is angry and his attitude is evasive, angry and suspicious.
The male nurse returns with the results from Israel's blood and urine tests. They are negative. Now Israel's sure he's on his way home, until a patient's rep comes by with a "right of patients" form, which lists the right to have an attorney at any time and the right to make and receive phone calls. He tells the rep everything that's happened. The rep looks surprised and says she'll check it out. Israel doesn't see her again.
Lewis returns and says she's confused about the conflicting stories presented to her. Nevertheless, she tells him they are going to ship him over to the VA hospital (Israel was a boatman's mate in the U.S. Navy from 1985 to 1988) for a psychiatric evaluation. On what grounds? he asks. She says that based on the comments of his sister and ex-wife--both of whom have said that Israel is given to mood swings and hallucinations--he should be held until a full psychiatric evaluation is performed at the VA.
Lewis writes in her medical report, "The patient was initially placed on the mental health hold by myself. I explained to him the disparity in the two stories that I was receiving was somewhat concerning and that I felt that we could only err on the side of caution."
Her impression: Questionable mood disorder. Questionable alcohol abuse.
Lewis goes on to note that Israel "essentially consented" to the hold. Israel, however, is thinking about how he can't miss work. Lewis offers to write him a note and tells him to let the VA figure things out.
Israel asks for a lawyer. He's scared and he's pissed. He doesn't want to go to the VA. He's told he can ask for a lawyer at the VA.
The paramedics enter; they'll take him by ambulance to the VA. They're the first to address him with the slow, exaggeratedly clear speech people use when speaking to the hard of hearing, the elderly and the mentally ill.
Usually paramedics wheel patients out on a gurney, but these paramedics allow Israel to put his clothes on for the walk to the ambulance that will transport him to the VA. On the way, rain begins to fall. Israel tells the paramedics what's happened to him, and one of them shows him his emergency mental-illness report, the form that is filled out when a person is placed on a mental health hold. Here, his appearance is "neat," his facial expression merely "perplexed," his physical activity "normal," his attitude is "composed," "polite" and "cooperative," and his speech is considered both logical and normal.
That form was signed at 6:20, so it appears the decision to hold Israel was made shortly after he arrived. Israel wonders why he wasn't moved out of Lutheran before 10:30, if the staff had concluded hours earlier that he needed to be held. He also can't figure out why he's being held if the initial report indicates that he is polite and cooperative and sober. Israel has not been able to get to a phone to call anyone.
Israel is driven across town and checked into the VA. His vital signs are taken again, and he's led up to the seventh floor. There is admission paperwork to sign, and he's given a brief orientation. Dr. Rachel Norwood, a psychiatrist, arrives, and Israel again begins asking: How can he be held on the word of his ex-wife and his sister?
Familiar questions follow: What day is it? Where is he? Who is the president? Israel changes his mind about wanting some character witnesses, so Norwood takes down the numbers of his girlfriend, Patricia, and Gene Essman Jr., a friend of Israel's for twenty years. Israel signs a release granting Dr. Norwood permission to speak with them and with his sister. Soon afterward, he will call Patricia to tell her what's going on.
"Either you're a hell of an actor, or your sister's got some problems," Norwood tells him.
More than a year later, Israel's sister, J.J. Beumer, doesn't recall that he was over at her house two days before the police took him to Lutheran. She says she hadn't heard from him in days--no one had--and she took that as a sign that he was growing withdrawn and depressed. She didn't want to have to endure another depression like the one she had seen over the holidays. Beumer also says he had quit his job right before he was committed.
Israel's ex-wife, Karen Barrett, says much the same. "Around May, he was withdrawing, quit a job--we thought we couldn't go through this again," she says. Barrett says both she and Beumer talked with a therapist who had conducted a "relationship" class Barrett had taken. The therapist recommended they call the police. The call to police had nothing to do with Israel's behavior on Wednesday, May 16, but rather with possibly erratic behavior months earlier.
"In all truth, if we were going to make this call, it could have happened at a better time. It should have happened at Christmas," Barrett says now. "But we were so concerned that it was going to happen again."
Israel's friend Essman disputes their account. "He's had a couple bouts of depression at Christmas time the last couple of years," Essman allows. "He couldn't get to see his daughter. But he never lashed out. He would drink a little bit, but during those bouts of depression, he would pretty much stick by himself." Essman says Israel did take out his gun once: After he and Israel had been drinking during a Super Bowl party a few years back, Israel pulled his gun from underneath the couch and fired a round into one of the concrete walls.
Beumer and Barrett, on the other hand, paint a picture of a man who is frequently depressed and was so downtrodden around Christmas 1997 that he remained immobile on his couch for weeks. They both say he tried to kill himself once (by overdosing on Tylenol) ten years earlier, when he and Barrett divorced. Beumer says her brother once fashioned a noose and describes him as a man who drinks excessively and is a pathological liar.
Beumer says that when she called Lutheran and then called the police, she merely wanted to make sure Israel hadn't killed himself. After all, she says, he had talked about killing himself during his Christmas-time depression. To her, it looked like he was going down the same path, so she called the police and told them her brother was depressed and didn't want to live. One brother in the family had killed himself years before, and she knew Israel had a gun in the house. She says she doesn't know where the part about not taking his medication came from, since he wasn't on any--though Lewis's medical report indicates that it was Beumer who had told police Israel wasn't taking his medication.
"If you think he was a threat to himself, it would be foolish not to call," Beumer says. "I really thought he'd be dead."
May 7, 1998, 1 a.m.
Israel is shown to his room on the seventh floor. A nurse can tell he's nervous and hands him half a pack of smokes. He spends the next hour in the smoking area, an outdoor patio sealed off with a metal fence. The rain is coming down hard now, it's windy and cold, and Israel is wearing only the clothes he had on when he left his apartment: black jeans and a red polo shirt.
As he smokes in the gloom, trying to figure things out, a nearby patient laughs uncontrollably. The guy keeps talking to himself and then cracking up. Israel finishes smoking and goes back to his room. He hears another patient screaming. "Stop!" the man shouts at Israel as he walks past. "Help me! Help me! I need medication."
Israel is scared. He can't sleep. He lies on the bed, then goes outside again for some air. He returns to the room and finally nods off around 3:30, but his sleep is broken up by a woman cussing someone out at the top of her lungs.
Israel walks to the lounge for coffee and a magazine. He's drained in every way, "whacked out." In the hall he runs into Joe, a stocky, older man with tattoos and a wrinkled face. Joe follows him back to his room and starts telling his story: He was med-evac'd out of Vietnam in 1968 and is addicted to methamphetamine. They chat for a while, but mostly Israel sips his coffee and waits for Joe to leave.
The VA is a clean place. The floors are shiny, the furniture is nice, and the white walls smell freshly painted.
Dr. Norwood brings Israel's release forms, which he signs. She asks if he got any sleep. A few hours, he says. He is still scared. She says she'll call everyone and come see him in the afternoon.
He washes up and then goes to lunch, where they're serving turkey and mashed potatoes. He's hungry but can't force down more than a few bites. Israel calls Essman and asks if he can come by. But Israel does not call his job. The last thing he needs is to tell his boss he's locked up in a mental institution, has no idea how he got there and no idea when--or if--he'll be getting out. Israel believes that if he's not out of there in 72 hours, his life will be over.
Essman comes at 2:45 with cigarettes. The two friends go outside and smoke and talk about J.J. Neither of them can make any sense of the last 24 hours. Essman can tell his friend is worried.
Israel is screened by the VA staff. He is reported to exhibit a minimal amount of guilt that he wasn't more involved in raising his daughter but denies periods of irritability or euphoria. He does admit to being "nervous"--experiencing insomnia a few times a month. He demonstrates "no behavior suggestive of dangerousness to himself or others."
May 7, 4 p.m.
Israel is back in his room. Dr. Norwood returns, having talked to Beumer, Barrett, Essman and Patricia. Norwood says the only thing they all agree upon is that Israel has some unresolved anger toward his ex-wife. Other than that, Israel's sister is describing one man, his friends another. Israel says he's not angry at his ex-wife, just disappointed at the way she's raising their twelve-year-old daughter. Norwood says she has no reason to keep him. She says she'll confer with another doctor and try to get him released tomorrow. That makes him feel better, but she tells him that she can't make any promises, and his spirits crash. He sees his whole life going up in flames. He'll lose the respect of his daughter because she'll think he really is insane; he'll lose his apartment, his job. His record will state that he spent time in a mental institution.
He goes to his room and prays. At dinner he still can't bring himself to eat, so he smokes. Later he watches TV and tries hard to stay calm. Maybe I won't be able to see my daughter again, he thinks.
Someone comes by and says he's going to be moved in with other patients because someone else needs his room. Israel grabs up his hospital pajamas and goes to his new quarters, where he meets two new roommates. One is a pleasant guy who's on the psych ward because he inexplicably likes to cut himself. (The next day Essman observes the man tapping on picture frames in the hall, checking to see whether they're made of glass.) The other guy is nice, too, but quiet. Israel never does learn his story.
Israel lies on his bed, trying to read. He wants to brush his teeth, but he has no money to buy a toothbrush and paste. He also wants to take a shower, but he's just too frayed to take his clothes off and chance it. Who knows what might happen there?
So he stays in the room and winds up with a severe headache. The rest of the night he goes outside and watches TV, comes back to the room, tries to sleep and can't, asks a nurse for a pen and some paper and spends several hours writing down his thoughts. Sometime past two, he finally falls asleep.
May 8, 5:30 a.m.
Israel's head is still pounding and his eyes are burning because his contacts have been on for more than 36 hours, and he can't take them out because he has nothing to clean them with. A patient in a hospital gown and sandals is walking up and down the hall performing an impromptu revelry, clapping his hands as loudly as possible and chanting. The loud woman from the day before is stirred to her own outburst: "Motherfuckers! I want out! Get me out of here!"
At breakfast Israel stares at pancakes and juice. A nurse asks why he's not eating. He explains that he hasn't had much appetite since he arrived. Is there something you'd like for lunch and dinner? she asks. His heart races: He might just be here for good.
He goes to his room and weeps. Then he pulls himself together. Norwood has already told him that mingling with the others will help his chances of getting out. He goes to a weekly meeting of patients to discuss living conditions. Norwood comes in and gives him a quick glance but doesn't acknowledge him again. Another bad sign, he thinks. The meeting lasts an hour. He keeps his mouth shut, hoping he won't be at the next one.
Norwood tells Israel that she spoke with Israel's mother, who lives in Oklahoma. Norwood says Israel's mom has told her that he is a problem child and that she's scared about what he might do.
Israel promises Norwood that he'll get rid of his gun as soon as he gets home. She hands him his discharge report. It reads: "Mood disorder--not specified." She had to put something down, she tells him.
"Do you need family counseling?" she asks.
"I could probably use some," he says.
She writes down the name of a psychiatrist and tells him to call if he wants to make an appointment.
More TV, a few more cigarettes. Norwood finds Israel and says she's talked to J.J. about his release and that J.J. is glad he's okay. Norwood tells him he's been caught in the "crossfire" of a dysfunctional family. He should try to protect himself from letting this happen again, she says.
His psych evaluation indicates that Israel is "calm, cooperative" and without any "overt mood instability, vegetative or manic or psychotic symptoms."
He fills out a final questionnaire, receives his keys and leaves. He walks up Colfax, stops for some money at a 7-Eleven ATM, buys a Gatorade and waits for the bus. "This is bullshit," he thinks to himself on the ride home.
According to the Colorado Revised Statues, a person can be placed under an involuntary emergency-mental-health hold if he appears to be mentally ill and is an imminent danger to others or to himself, or appears to be gravely disabled. In recent years, several court decisions have congealed to create an additional standard known as "potentiality." Now, if doctors fear a person is not currently but soon will become an imminent danger to himself or others, he can be held against his will.
The State of Colorado does not keep records on the number of mental-health holds at private health-care facilities, but it does track holds placed by the state's three largest public mental-health centers--which account for the majority of such holds. In fiscal year 1998, Denver Health Medical Center admitted 837 patients against their will (the Fort Logan Community Mental Health Center made 352 such holds, and the Pueblo Mental Health Center made 459). A small number of individuals are released after 72 hours, while the majority voluntarily consent to additional treatment.
Lutheran Medical Center has declined to answer several specific questions about Stan Israel. Instead, the hospital issued a statement reading: "We believe that Mr. Israel's case was handled appropriately and with the utmost care. The assessment conducted in the Emergency Department was proper and thorough. Both the Emergency Room physician and the psychiatrist on call agreed with the procedure recommended in this case." Dr. Lewis did not return several phone calls from Westword seeking comment. The VA's Dr. Norwood has also declined to speak with Westword.
Denver Assistant City Attorney Morris Evans defends institutions in cases like these. He thinks the potentiality standard--which makes it easier to hold people against their will--is a good idea.
"If you're saying you don't want dangerous, mentally ill people in the community unless they're treated, ipso facto you have to include the concept of potentiality," Evans says. "Otherwise, you have to wait until something happens, and then it becomes a criminal matter."
That Israel volunteered to go to the hospital may not have helped him, either. "A person does it with the intention of doing the right thing," says one physician who asked not to be identified. "The emergency room perceives that this guy wouldn't come down unless he was really distressed."
May 8, 1998, 4:30 p.m.
Stan Israel arrives home. He is relieved, dead tired, grimy and pissed.
He heads straight to the shower to clean up. Israel is free, but far from satisfied. For days he cannot eat much, can't sleep. He has nightmares of being locked up. He wants to take his revenge: lawsuits against Lutheran for keeping him against his will, against his sister for reporting false information, against the cops--surely they knew what was going to happen and lied to him to get him to go along.
The Lakewood police will not discuss the specifics of Israel's case. Agent Mary Munger, one of the officers who transported Israel to Lutheran, has no comment for Westword; her partner, Agent Tracy Lee, did not return several phone calls seeking comment. Lakewood police lieutenant John Camper, who oversees officers on patrol, speaks generally about what happens when his officers respond to a potential mental-health call. "Maybe it's a pendulum," he says. "On one end, you have what the person is saying; on the other, you have what the reporting party is saying. You have to weigh them. It's not an exact science. I would very much doubt that [an officer] would say, 'Let's straighten this out.' That would be an odd thing to say. For crying out loud, what gets straightened out at a hospital? But I just don't know."
May 11, 1998
It's a busy day for Stan Israel. He mails a letter to the American Civil Liberties Union, explaining what happened. The same day, a judge issues a temporary restraining order against Israel's sister, prohibiting her from coming any closer than 500 yards from him. It's Israel's way of making sure his sister doesn't make any more calls.
He also visits Lutheran Medical Center to get his records. In almost every situation, a hospital must release records to a patient requesting them, but there is an exception: If medical personnel feel that the patient will harm himself or others as a result of receiving his records, they can turn him down. That's what the hospital did in this case.
Israel returns to work. But he feels as if his boss is treating him differently, and he resigns a week later.
At the end of May, the ACLU contacts Stan Israel.
It takes until August before a third-party reviewer concludes that Lutheran's release of Israel's records would be "unlikely to have a significant negative psychological impact on him."
In the fall of 1998, the ACLU's legal panel accepts Israel's case, and in November the organization begins trying to place it with a cooperating attorney. For a while, the ACLU spent some time exploring "whether the emergency-room physician, going on information from the sister, had enough information to hold him involuntarily, when at least one portion was refuted immediately--that he had been drinking," says ACLU legal director Mark Silverstein. "The police officers immediately knew that piece was inaccurate. Should that prompt extra caution in evaluating and relying on the rest of the information?"
But the ACLU dropped the case in May. "To the extent that lawsuit would be questioning the action of a physician who authorized the 72-hour hold, we felt we needed to talk to people in that exact professional specialty and get their opinion on it," Silverstein says. "We checked with two who felt they might have very well done the same thing."
Other doctors aren't so sure. "I don't know how they made that decision if he wasn't displaying any behavior that was a threat to himself or others," says Dr. Joan Laub, who runs a private practice that deals with the psychological fallout people endure when they've been in accidents or the victims of crime. Laub has placed patients on mental-health holds before but says she does so "rarely."
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But Silverstein says the hospitals figure "it's better to be sued for false imprisonment than wrongful death. That might be good business."
Today Stan Israel lives with his girlfriend. Since he left Tru-Check, his employment stops have been brief: a few months on contract as a customer sales rep for a cable company, a stint at Just for Feet. Now he works at an auto-detailing shop and is trying to design Web pages. "I do have a problem holding a job," he says.
Recently, the members of Israel's family have begun talking to each other. The home of Israel and Beumer's parents was destroyed in the recent tornadoes in Oklahoma, and that has brought them a little closer--but only a little. Beumer "imagines it was quite frightening" for her brother to be locked up in a psych ward, but, she says, "there's no more that I can do for him. I'll have a clear, free conscience when he kills himself, 'cause I know I tried."
"It's ridiculous," Israel says of his experience. "You take their blood test, take their piss test, and you're nice to people, and they base it on hearsay. Something's wrong.