Monday, April 14, 2008

Mental health reform flaws, laid bare -
Greensboro (NC) News Record

So far, Tlny Zichi has been unable to face a first-degree murder charge, with experts split on whether he is competent to stand trial.

By Lorraine Ahearn
Staff Columnist

ELON — These days, Tony Zichi is finally where his doctors and his family argued he should have been all along: in a maximum security state psychiatric ward, for treatment of severe schizophrenia.

The irony?

It took a homicide to get him there.

It took the brutal stabbing in 2005 of 84-year-old Ruth Terrell, a resident of a small, quiet elder care home where mental health authorities placed Zichi, then 25, despite his well-documented history of violence.

So far, Zichi has been unable to face a first-degree murder charge, with experts split on whether he is competent to stand trial. After an attempt to pick a jury in February, an Alamance judge ordered Zichi taken back to Dorothea Dix hospital.

But in the meantime, two massive civil actions by the elderly victim's survivors — one against local authorities, the other against the N.C. Industrial Commission — are beginning to grind their way through the courts.

Laying bare the inner workings of mental health "reform" — North Carolina's attempt to close state facilities and send the mentally ill back to the community — the lawsuits could accomplish the very thing that no amount of advocacy or newspaper articles have so far: Force a change.

"This is the worst case the state has seen," said James Roane, a nursing home attorney who filed the lawsuits for the victim's son and daughter.

"Everybody knows the system is broken. It's my intention to bring this to the public, and bring it to the legislature. That's all we want to do."

At the heart of the case is an ongoing practice the state calls "mixed populations" — a euphemism for placing mentally ill people in facilities that are instead designed to care for the elderly.

In the Zichi case, that would be the Evans Forever Young Family Care Home. The brick house in the country, two doors down from a horse farm near Western Alamance High School, was home to four elderly women when Zichi was placed there.

"Exhibit A" in the case is the admitting form that Alamance-Caswell Mental Health officials filled out for the home's operator. Though Zichi's diagnosis is listed — "schizoaffective disorder, polysubstance abuse, antisocial personality" — none of the boxes to indicate "inappropriate behavior" are checked off. Those boxes, left blank, included, "injurious to others."

In fact, Zichi had a history of violence, his criminal record shows. He had been placed — and kicked out of — seven group homes in four years, including one in Guilford County where in 2002 he stabbed a younger male resident in the neck with a pencil, according to court records.

In Burlington, he punched a female group home resident in the face and held her down, records show. He was also convicted of stealing a revolver and pointing it at someone.

The Alamance-Caswell physician who signed the form, Dr. Julia Snow Knerr, has declined through her attorney to explain the omission, citing patient confidentiality.

Zichi, who allegedly became increasingly paranoid and delusional because he was vomiting up the medication used to stabilize him, had been at the home near Elon for three months when the stabbing occurred.

On the night Terrell was stabbed with a knife from the kitchen, she had been asleep. In the two weeks that she was later hospitalized before dying of complications, police said she told witnesses that Zichi had jumped on top of her and tried to strangle her before stabbing her multiple times.

Nursing home operator Erma Evans, a defendant in one of the lawsuits, denied in court filings Zichi had posed immediate problems and threatened her staff. Evans conceded that Zichi had "some adjustment problems," but maintained that she "met all her legal responsibilities and was not negligent in any way."

Although Zichi is also named in the lawsuit, the attorney for the victim recently let both Zichi's mother and the Alamance Department of Social Services out of the action, which alleges negligence, medical malpractice, wrongful death, assault and battery, and fraud. Attorney Roane said DSS workers had been "desperate" to have Zichi moved from the nursing home.

And after a deposition with Zichi's mother, Catherine, Roane concluded the mother had searched exhaustively to find him a proper placement when they could no longer manage him at home.

"She complained to everybody she could think of, she wrote letters," Roane said. "But nobody wanted him. Not the ER, not the 'supervisory unit,' not the jail, not the group homes. So they put a 25-year-old man with a history of violence in a home with elderly women. What do you think is going to happen?"

The Zichis declined to comment because of the pending murder trial, but a mental health advocate who led their family support group described the family's unsuccessful efforts to have their son, who was diagnosed as schizophrenic at age 20, confined to a state hospital.

Support group leader Eileen Silber, past state president of the National Alliance on Mental Illness, said because of the thrust to close mental hospitals, Zichi didn't qualify for the limited bed space.

"This system is so broken and fragmented, there was no room to put him in a state hospital," Silber said. "But when you deliberately put someone like Tony in a residence like (the Evans rest home), you are not concerned with the public safety."

Zichi, after running a mile from the house on the night of the stabbing, allegedly told sheriff's deputies he was seeing "rats."

He frequently suffered delusions that the CIA and the Mafia were after him, according to court records, and during a court hearing in February, he sobbed when he saw his parents in the courtroom, then stopped talking completely.

Though Zichi had been a bright, athletic student before the onset of his illness, Silber said Zichi's parents had long resigned themselves to the idea their son could not function in the community, but might well have to spend the rest of his life hospitalized.

For the first time, Zichi is where his psychiatrists recommended — a locked facility with mental health staff and doctors to monitor his powerful psychotropic medication.

"But it took this," attorney James Roane said, tapping his finger on a photograph of Ruth Terrell, who spent her 85th birthday in the hospital, just before her death.

Roane concluded there were "two victims" in the case — one a sick young man needing treatment, the other, an elderly woman who needed protection from harm.

"We are literally dumping mentally ill people in with the elderly, and for the foreseeable future, it's not going to change. We need state-run facilities. That's it. They're going to have to find the money.

"Because this," Roane said, tapping the photograph, "is not working