A Death in the Family
Aided by advocates for the mentally ill, William Bruce left the
hospital -- only to kill his mother
By ELIZABETH BERNSTEIN and NATHAN KOPPEL
The Wall Street Journal
August 16, 2008; Page A1
On June 20, 2006, William Bruce approached his mother as she worked at
her desk at home and struck killing blows to her head with a hatchet.
Two months earlier, William, a 24-year-old schizophrenic, had been
released from Riverview Psychiatric Center in Augusta, Maine, against
the recommendations of his doctors. "Very dangerous indeed for release
to the community," wrote one in William's record.
William Bruce, left, with his father, Joe Bruce, who feared his son's
release from a psychiatric facility.
But the doctor's notes also show that William's release was backed by
government-funded patient advocates. According to medical records, the
advocates -- none of them physicians -- appear to have fought for his
right to refuse treatment, to have coached him on how to answer
doctors' questions and to have resisted the medical staff's efforts to
contact his parents. As one doctor wrote, William told him his
advocates believed he is "not a danger, and should be released."
William's father, Joe Bruce, obtained his son's medical records from
Riverview eight months after the killing. "I read through the records
and I just remember crying all the way through," Joe Bruce says. "My
God, these people knew exactly what they were sending home to us."
Helen Bailey, one of William's advocates, declined to discuss the
details of his case but says the handling of it was consistent with
her professional duties. "My job is to get the patient's voice into
the mix where decisions are made," says Ms. Bailey, an attorney with
Maine's Disability Rights Center in Augusta. "No matter how psychotic,
that voice is still worthy of being heard. I have not had the person
who is so out of it that they can't communicate what they want." She
added that the records reflect the doctors' perception of what
happened.
The story of William Bruce -- based on medical records made available
to The Wall Street Journal -- as well as interviews with relatives,
doctors, advocates and hospital administrators brings into sharp focus
the impact of a little-known government-funded advocacy program for
psychiatric patients.
Attempt to Curb Abuses
Congress created the national Protection and Advocacy for Individuals
with Mental Illness program, or PAIMI, in 1986 to curb abuse and
neglect of the mentally ill, primarily in institutions. In the 1960s
and 1970s, many abuses were uncovered at hospitals, where patients
were physically restrained, neglected or overmedicated.
The PAIMI program, operated by the Substance Abuse and Mental Health
Services Administration with a 2008 budget of $34.8 million a year,
funds protection-and-advocacy agencies in each state. Typically
nonprofits, these groups sometimes receive supplemental funding from
states. According to a 2007 SAMHSA re****t, the agencies served 19,000
people in 2006.
Some doctors, hospital administrators and mental-health veterans argue
that advocates are endangering the mentally ill and the public by too
often fighting for patients' right to refuse treatment. Many advocates
"have a strong bias," says Robert Liberman, a director of a
psychiatric rehabilitation program at the University of California,
Los Angeles.
"I don't know if they are doing people a service when they assert the
right of mentally-ill individuals to remain psychotic," says Ron
Honberg, director of policy and legal affairs for the National
Alliance on Mental Illness, an education, sup****t and advocacy group.
Proponents of patient advocates say they're essential to protecting
the rights of the mentally ill. The National Disability Rights
Network, which provides lobbying and other services for the patient-
advocacy system, says advocates play a critical oversight role.
They cite the 2006 sentencing of the owners of a Kansas treatment
facility on charges that they subjected patients to forced labor and
involuntary servitude, and a class-action lawsuit alleging that female
patients of the Lincoln Regional Center in Nebraska were raped and
assaulted by a male staff member. The latter case was settled in 2007
with the hospital, which denied liability, agreeing to more thoroughly
investigate assault complaints.
The mentally ill are "very vulnerable," says Curt Decker, executive
director of the National Disability Rights Network. "There needs to be
an external, independent, legally based advocacy system to make sure
they are being treated fairly, equitably and safely."
John Morrow, senior public health advisor at SAMHSA, declined to
discuss the Bruce case. But he says advocates serve a very im****tant
function, and that the organization has resolved thousands of cases of
abuse and neglect.
In recent years, there has been a wave of legislative efforts, many
inspired by violent crimes, to make it easier to mandate treatment for
the mentally ill. Advocates have blunted those efforts in California,
New Mexico and Michigan.
In Michigan, advocates successfully pushed for limits to a 2005 law --
proposed after a schizophrenic killed a young man -- mandating
outpatient treatment. "They have a left-wing, individual-rights-at-all-
costs agenda," says Virg Bernero, mayor of Lansing, Mich., who helped
pass the law when he was a state legislator.
"Our legal mandate is to protect the rights of individuals," says
Elmer Cerano, executive director of Michigan's PAIMI chapter. But, he
says, "rights are limited when it comes to safety."
Despite advocates' objections, Joe Bruce -- with the help of his pro-
bono attorney, Robert Owen of Fulbright & Jaworski LLP in New York --
successfully lobbied the Maine legislature to pass three bills. One
gives mental-health professionals greater leeway to disclose patient
information to those who may be affected by that person's conduct.
Another makes it easier to medicate involuntarily committed patients.
William Bruce grew up in Caratunk, Maine, a picturesque town of about
110 residents nestled in the state's northern hills. His father, a
rugged, talkative man, worked as a senior technician for the Maine
Department of Trans****tation. His mother, Amy, served as the town's
treasurer. The oldest of three boys, William grew up in a 100-year-old
farmhouse that sits on the banks of the winding, rock-strewn Pleasant
Pond Stream.
Even when Willy -- as he was known as a boy -- was young, "there was
just something different about him," his father says. Although cute
and energetic, William was hyperactive and deeply self-centered, his
father says. And he could turn suddenly violent: When he was four, he
pushed his younger brother down the stairs. At five, he broke the same
brother's leg, his father says.
As an adolescent, William was handsome, popular with girls and deeply
troubled, attempting suicide at 14. He would sometimes see therapists,
but would quit and stop taking any prescribed medication, Joe says.
William's behavior particularly pained his mother. Tanned and
athletic, Amy loved kids, often hugging her own and opening her home
to neighborhood children. But Joe says she was seldom able to
emotionally connect with her eldest son, and repeatedly blamed herself
for his problems.
After dropping out of high school, getting his equivalency degree and
serving in the Army, William bounced among low-level jobs and had a
few minor brushes with the law. On Christmas Eve, 2003, Joe says
William had his first psychotic episode in a Target store, telling his
father that the security cameras were monitoring him.
But he refused to seek treatment, and his family couldn't insist.
Maine, like many states, requires that the mentally ill pose a
substantial risk of harm to themselves or others, based on recent
evidence, to be involuntarily committed.
In March 2005, after William threatened two men with a loaded AK-47
assault rifle -- his father is a licensed gun dealer -- William went
to a psychiatric facility in Bangor. He was eventually released but
stopped taking his medicine.
William deteriorated. Sometimes he walked into neighbors' homes
unannounced. Once he put his mother in a headlock. In January 2006,
William punched his father in the face, screaming, "You have disobeyed
direct orders from a superior officer in the CIA." He was sent on Feb.
6, to Riverview, an extended-care psychiatric facility.
'An Awful, Awful Feeling'
"We were certain he would be released," Joe Bruce says. Waiting for
that day "was an awful, awful feeling."
A few weeks after William Bruce's admission, psychiatrist Jeffrey
Fliesser wrote that William was hostile, paranoid and "dangerous to
others without additional observation and active attempts to treat
him," an opinion he reiterated over the next five weeks. The doctor
also wrote that he urged William, now diagnosed with paranoid
schizophrenia, to take medication, but William refused. Dr. Fliesser
declined to comment about the case for this story.
William began working with advocates employed by the Maine Disability
Rights Center, which receives funding from the federal PAIMI program
as well as state and private sources.
According to a nurse's treatment record dated March 23, Ms. Bailey,
the advocate, told Riverview administrators she saw no do***entation
showing that William should remain hospitalized. Trish Callahan,
another advocate, suggested that William "may actually be getting
worse by remaining here," the nurse's record says.
"I repeatedly explained to the patient, his advocates and other team
members, his paranoid psychosis will not likely improve without
medication therapy," Dr. Fliesser wrote in his notes. Ms. Bailey says
she gives legal opinions, not clinical ones, and notes that her job is
to represent the client's wishes.
By the beginning of April, William Bruce's case was "in a high state
of contention," wrote Daniel Filene, a psychiatrist who had taken over
the case. On April 6, Trish Callahan, another advocate, attended a
meeting with William's treatment team. She stressed that William
should be discharged and that his summer job prospects were being
harmed by his continued hospitalization, Dr. Filene's notes say.
According to these notes, Dr. Filene suggested to William that he take
trips outside the hospital. When William voiced reluctance to venture
out, Ms. Callahan told William, "They want to see that you can play
nicely in the community. Just say 'Yes.' " He did. Dr. Filene asked
William if there was a risk he would refuse to return to the hospital
from a community trip. "Ms. Callahan told him, 'Just say no,' and Mr.
B. replied, 'No,' " the doctor wrote in his notes.
Dr. Filene wrote that he asked William for permission to speak to his
mother and his previous mental-health providers. Ms. Callahan said
there would be no benefit and that William's parents were "a negative
force in his life." William refused to give consent, Dr. Filene's
notes say. On April 11, Dr. Filene wrote that William said his
advocates were telling him that he is "not a danger and should be
released."
Ms. Callahan didn't respond to requests seeking comment. Dr. Filene
declined to comment about the case for this story.
"I think the advocates overstepped their bounds," says Riverview
Superintendent David Proffitt. William "was relying on the people
whose purpose it was to ensure his civil rights were being exercised,
and unfortunately that interfered with his other right, which was to
get medical care."
Ms. Bailey, Ms. Callahan's superior, doesn't believe the advocates
prevented William from getting medical care. "There is nothing in the
William Bruce case that is contrary to the way we do business," she
says, adding that it is the hospital's responsibility to try to have a
patient committed or forcibly medicated.
William Gets Released
More generally, Ms. Bailey says it isn't a given that families of the
mentally ill should be involved in decisions involving their care.
"There are some God damn nasty families out there," she says. SAMHSA
declined to comment on the case, as did the Maine Department of Health
& Human Services.
In the end, Dr. Filene wrote that while he recommended William stay at
Riverview, William appeared very unlikely to meet Maine's legal
criteria for further involuntary hospitalization beyond his court-
ordered commitment term, which expired at the end of April. On April
20, 2006, William was discharged.
William was soon back home. He hid steak and butcher knives in his
bedroom and spent hours pacing in the driveway, giggling and babbling
unintelligibly to himself. Joe began calling to check on his wife
several times a day. "It was the worst we'd ever seen him," he says.
On June 20, two months after his son's release, Joe Bruce returned
home from his office to find his wife's battered, bloodied body.
William was gone.
"My son has killed my wife," Joe told the 911 dispatcher, later adding
that he was arming himself in self-defense.
According to the medical examiner's re****t, Amy died of multiple blunt-
force trauma and chop injuries to her head. She was 47 years old.
Police arrested William Bruce at his grandparents' house and later
charged him with killing his mother. He told a psychologist that the
Pope told him to kill his mother because she was involved with al
Qaeda and Saddam Hussein. Joe Bruce became William's legal guardian
and gained access to his medical records.
When police returned Amy Bruce's purse to Joe, he found an unsent
letter she had written to her eldest son.
"I've always had this horrible feeling that I've let you down in some
way," she wrote. "The only wish I have is that someday we can look
each other straight in the eyes and say I'm sorry and I love you more
than life itself." She added: "I will not give up on you ever."
In March 2007, William was found not criminally responsible by reason
of insanity and was committed to Riverview again, this time
indefinitely. At the end of 2007, faced with the possibility of being
restrained and medicated against his will, William agreed to take
Abilify, an antipsychotic drug. Within weeks, his mental status
improved.
'I Blame Myself'
William Bruce, now 26, is strikingly handsome, his dark hair slicked
back. Sitting in a Riverview conference room on July 23, he spoke
courteously but deliberately. It was the first time he has been
interviewed about his case.
"I blame the illness, and I blame myself," William said of his
mother's death. "The guilt is...," he paused, struggling to find a
word "...tough."
William said the first time he came to Riverview, he refused to
believe he was mentally ill and approached the advocates because he
wanted out.
"They helped me immensely with getting out of the hospital, so I was
very happy," he said. He later added, "The advocates didn't protect me
from myself, unfortunately."
These days, William is taking criminal-justice cl***** online through
Colorado Technical University. He points proudly to his 3.94 grade-
point average and says he hopes to attend law school to learn more
about mental-health laws. William and his father talk on the phone
almost every day. "He stood by me the whole time despite the horrible
tragedy...despite what I did," William said. "I am the man I am today
because of my dad."
While William believes patients deserve some protection, he said he
understands his father's fight to strengthen commitment and treatment
laws. That fight took another turn last month, when Ms. Bailey and
another attorney filed a lawsuit that could undermine ****tions of a
law Joe sup****ted. The suit, filed in U.S. District Court in Maine, is
directed at the law which makes it easier for hospitals to compel
patients to take medication.
"There are times when people should be committed," William said.
"Institutions can really help. Medicine can help."
"None of this would have happened if I had been medicated."
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