Update: Food for Thought. 

Mental Health Reform- Long Overdue. 

RE: I have thus far found Mr. ToersBlijn's contributions to the discourse specific to Arizona's shortsighted and graphically inept behavioral health care system very enlightening, and directly relevant to my work as it stands. Thus, as per Mr. ToersBlijn's express permission, I offer my own feedback, as follows.  This is a partial aspect of my response in this context. 

My further comments in red, below.

Mental Health Reforms ~ Long Overdue
By Carl R. ToersBijns

Arizona lawmakers should heed the warning of the recent Newtown shooting and take immediate proactive steps to avoid such a mass shooting by a mentally ill person in our schools or other public places. The solution to this problem is multi-fold but we must be convinced by now that those persons identified to be mentally disabled or ill must receive better treatment and this process must be addressed in a most effective and expedient manner.

While hospitalized at ASH, and after my discharge, I directed a number of very straightforward, civilly expressed and well worded requests to several Phoenix area law makers, and even to Tucson based representatives who I felt should take an interest because I am a Pima County voter (Tucson), lawmakers whose names I will leave aside for now. I did this, for example, in direct relation to the unreported Jesus Rincon Murietta escape and the consequent murder of April Mott, as well as in relation to concerns I had (and still have) about the Phoenix police departments' unwillingness to respond to good faith reports of staff physically abusing patients (inc. me on one very specific occasion), all of which I was able to document. However, short of one or two form letters from these particular members of the Arizona senate and house, each of whom did nothing other than divert the matter towards someone else, I heard nothing nor received any support at all. (PJ Reed)  

This should be identified as a two step healing process and will require legislative reforms in order for the process to be effective and applied to those severely mentally ill persons that live in our communities and prisons, yes prisons.

This is an excellent point. Nothing short of legislative reform flowing directly from legitimate information provided from CONSUMERS and other state citizens who have full experience in terms of Arizona's state behavioral health care system (including the author of this article, as well as someone like myself, and so on) is going to meaningfully address and resolve the deep set agency corruption and relatedly endemic shortcomings of a facility like ASH. And I commend Mr. ToersBijn for emphasizing the need for reform within the prisons themselves, too, in terms of mentally ill men and women incarcerated in Arizona's correction system. (PJ Reed) 

The first step is the prevention of crime by convicted felons released from prison and not tracked or clinically maintained to be stable law-biding citizens so they don’t pose a threat to our communities and their families.

Point in fact: The willful engagement of ASH's administrative staff in covering up Jesus Murietta's escape in late May, 2011, directly led to April Mott's brutal slaying in late August, 2011. And as I have written about at length in my blog, Jesus, a seriously mentally ill man around 22 years of age, is now going to have spend a major portion of his life in prison, rather than in treatment at ASH. I reported this matter to outside sources from the get go- all while still hospitalized at ASH- out of concern for A) Jesus' safety, B) the public safety, and C) for the fact that ASH's senior clinical and administrative staff were obviously covering the escape out in order to avoid accountability. But despite my best attempts to avoid the potential posed well before April Mott's death, and even later, when the four page feature article published on September 28, 2011, in the Arizona Republic newspaper, the Arizona Department of Health Services has taken no steps whatsoever to address the graphically clear wrongdoing of ASH's administration in this matter. (PJ Reed)     

The reason this is the first step is based on the fact that legislators have more control over legislation covering convicted felons than free citizens within our community. They can in fact mandate certain procedures and process a convicted mentally ill felon much like they can a sex offender under Megan’s Law and require them to register and maintain a treatment plan according to their parole conditions and release.

What needs to happen is for the various state officials and their charges in the state's agencies to abide by established law as it stand today. For there are already clear provisions of state administrative law applicable to these procedures, but I attest to the fact the Arizona Office of Attorney General blatantly defies/ignores  these laws, and are complicit in willfully granting the Arizona Department of Health the means to condone the wrongdoing at ASH and throughout the the whole of the state's behavioral health system go on unabated for many, many years. This, despite the good faith efforts of numerous individuals, including CONSUMERS (such as I), who have done nothing short of exercising their civic duty in order to report these matters. I have been party to a number of formal hearings in Arizona Office of Administrative Hearings, wherein very well documented evidence was presented to the court relating to very overt wrongdoing at ASH, only to have assistant AG Joel Rudd blatantly challenge the merits of such evidence in order to preserve the highly unlawful conduct as a matter of standard practice. Indeed, legislators need to do something now, because if the office of the Attorney General is willing to engage in such criminal behavior, than all the efforts of someone like myself are effectively futile. My primary concerns today lie with the patients at ASH, who are highly vulnerable and seriously mentally ill and disabled; but it is critical for all of us to realize that this fundamental fact is precisely how people like Rudd get away with pulling this sort of shit on an ongoing basis. (PJ Reed)

The second step is to address the void of severely mentally ill persons neglected or not placed within a therapeutic or clinical environment such as private or public funded outpatient treatment clinics, admission to the state hospital or other referred treatment based on professional diagnoses and treatment needs.

Again, an excellent point. My awarenesses as a mentally ill person extend to events in the state of Arizona that occurred prior to my formal admission to ASH. The tragic shooting that caused six deaths and severely wounded former US Congresswoman Gabrielle Giffords, for example, in Tucson, AZ, occurred three days before I was transferred from University of Arizona Medical Center (Tucson) to ASH on January 11, 2011. As the news of this event gained momentum over the following two weeks, we as a community were made aware of the fact that the shooter, Jared Lee Loughner, is a seriously mentally ill young man who had clearly exhibited very disturbing behavior in a variety of settings wherein the behavior could have been meaningfully addressed; and I also came to realize that I had encountered this young man in Tucson at the fall 2009 Fourth Avenue Street Fair, where he had set up a display designed to express his deep set concerns about socio-political disparity, and even then, I- a virtual lay person- sensed that Loughner was somewhat of a ticking time bomb. Regrettably, I had no idea at the time of what I might have been able to do, (and I still don't), but the fact remains, that "On that beautiful day, the mental health system failed us" (Patricia Maisch, November 07, 2012). So consider again the willful coverup of the escape of a violent patient from ASH in late May, 2011, which in time directly contributed to the death of a young Phoenix woman, and my related concern over the fact that the state employees centrally involved in this particular debacle have never been held accountable within any sense of the term. For in that specific case, the state of Arizona already had the seriously ill man in a safe setting, but the incompetence of his primary care providers- who for some reason chose to take him off of all of his medications while still there within the confines of ASH- and related willingness of ASH administrators and officials within the executive infrastructure of the Arizona Department of Health Services to allow this matter stand as it has, with no due action on behalf of the public in general. How many more innocent people will have to die or otherwise suffer the gross ineptitude of these resources before we, the people, take action in our own right and see that our lawmakers 

do their jobs in this context? (PJ Reed)

paoloreed@gmail.com

Food For Thought: Carl R. ToersBijns 

      Mental Health Reforms: Long Overdue 

  Thank you to: David's Hope- The Arizona Mental Health and Criminal Justice Coalition

Carl ToersBijns is a former Deputy Warden in the AZ Department of Corrections and has 25 years experience in Corrections. As such, his experience is somewhat akin to Arizona State Hospital Chief Executive Officer Cory "crazycorycorner" Nelson's, this in the sense that Nelson's initial administrative experience was attained in the state of South Dakota Department of Corrections, straight out of college.  ToersBijns, however, has far more experience than Nelson, (25 years, as compared to Nelson's 12 year career, to date), and as such, his knowledge and understanding of publicly managed institutions runs long and deep. Thus, I feel it imperative for anybody sharing my concerns about the substandard mental-medical health care conditions at ASH and the role that the Hospital's administrative staff plays in condoning the ongoing patient abuse at ASH to pay attention to the following essay. It was passed on to me by the good folks with David's Hope- Arizona Mental Health and Criminal Justice Coalition, an organization dedicated to mental health care reform specific to the role that the Arizona Department of Corrections is obligated to fill in terms of the same public trust that The Arizona State Hospital is required to meet. Anyone paying much attention to my blog and the various articles that I have written about the incompetence of numerous high ranking ASH clinical staff, or the administrative corruption designed to preserve the status quo at ASH and throughout the AZ Behavioral Health Services agency, or the endemic state of fear imposed by ASH administrators onto the few good staff at ASH who might choose to speak out against patient abuse, and the racially discriminative mental health courts who for some reason grant Caucasians treatment at ASH at approximately 12 times the rate granted to African Americans, will find this essay highly on point.     

Mental Health Reforms ~ Long Overdue
By Carl R. ToersBijns

Arizona lawmakers should heed the warning of the recent Newtown shooting and take immediate proactive steps to avoid such a mass shooting by a mentally ill person in our schools or other public places. The solution to this problem is multi-fold but we must be convinced by now that those persons identified to be mentally disabled or ill must receive better treatment and this process must be addressed in a most effective and expedient manner.

This should be identified as a two step healing process and will require legislative reforms in order for the process to be effective and applied to those severely mentally ill persons that live in our communities and prisons, yes prisons.

The first step is the prevention of crime by convicted felons released from prison and not tracked or clinically maintained to be stable law-biding citizens so they don’t pose a threat to our communities and their families.

The reason this is the first step is based on the fact that legislators have more control over legislation covering convicted felons than free citizens within our community. They can in fact mandate certain procedures and process a convicted mentally ill felon much like they can a sex offender under Megan’s Law and require them to register and maintain a treatment plan according to their parole conditions and release.

The second step is to address the void of severely mentally ill persons neglected or not placed within a therapeutic or clinical environment such as private or public funded outpatient treatment clinics, admission to the state hospital or other referred treatment based on professional diagnoses and treatment needs.

This will be more tedious in nature as it requires the commitment of community resources in the mental health field as well as the involvement of many groups of mental health advocate groups that may recommend treatment alternatives to the legislative committee that in turn can pass legislation with minimum standards or treatment conditions to the mental health courts or superior courts for behavioral management purposes.

So ask the question – Where should the mentally ill be placed? Today most severely mentally ill persons that run afoul of the law are committed to state prisons. Society has released this responsibility to the prisons rather than mental health courts and every study made has revealed that the mentally ill do not belong in prisons just because there is no other place to put them. Severely mentally ill (SMI) persons do not cope or function very well in prisons and often get worse because of lack of mental health services available or provided in most populations.

These SMI persons often become targets or predatory non-mentally ill persons and abused and assaulted repeatedly without any relief or protection from the prison system.
Therefore they become more traumatized than when they entered the prison system and less likely to recover from such conditions resulting in suicides and other self-harm acts that puts them in a high risk classification.

There are other negative factors of putting SMI persons into prisons. Arizona has limited bed space for such SMI persons and must choose which SMI are housed within these diminutive treatment centers and which ones are ignored. It has been projected that up to 24 per cent of our prison population is in need for mental health treatment programs, medication and treatment needs.

These persons are subjected to lack of therapeutic environments that fosters healing and stabilization. They will risk being out of compliance of their medication because the side effects are detrimental to their coping skills and never talk to anyone about their choices or decisions thus basically left alone to cope the best they can.

They are often misunderstood by poorly trained correctional staff and classified to be behavioral misfits and placed into segregation for long periods of time while receiving either no treatment at all or worst, chemically restrained by psychotropic drugs that put them in a state of suspended functioning for the remainder of their time to serve until released from prisons.

Then upon their release date they are given a 30 day blister pack of medication and put out in the street or with families that have no meant either financially or socially abilities to maintain such medication or treatment needs. One must realize there is strong evidence of the large crossover between mental illness, criminal behaviors, incarceration and treatment.

Today the SMI persons in our community do not received adequate services or treatment as they require thus are stigmatized by society for being abnormal and thereby cast into prisons. This makes it society’s problem and often left unresolved because of funding or lack of services available in the demographics involved with such needs. Thus we have to ask a few more questions and glean the answers.

• Why severely mentally ill persons aren’t hospitalized or offered outpatient treatment through the mental health court systems?
• Where do these criminal behaviors originate and what preventive measures are available within the community to help them?
• Where do these SMI persons obtain the guns they use to commit crimes and what are the traditional barriers of such activity?
• Are the laws in tune with our socio-political, economic and environmental systems functional or are there dire changes needed?
• What prompts the mass shooting mentality and where are the loopholes, the communication breakdowns and observation reports?
• Who is responsible for this problem; society, policy makers or lawmakers?
• When an SMI commits a crime, what do we do with them and what options does society have to avoid criminalizing the mentally ill persons?
• Can the courts order medication involuntarily and do we need to revisit the forced medication procedures to include more mandatory treatment inside our communities and keep them outside our prisons?

The problem has long been discussed and looked at for the past 40 years. Ever since the courts ruled that an SMI had the right to refuse his medication. The problem is then multiplied by the number of mentally ill roaming the streets without medication. Not all are violent in nature but the fact is many do have drug or substance abuse addictions that exasperate their mental illness.

Thus the bottom line was the mentally ill persons were criminalized by their own means and the lack of protection for society by the laws passed and that have withstood time after time tests in court to be upheld. The homeless become victims of crime as they try to survive the environment without their treatment or medication needs.

Not all SMI persons are homeless or have alcohol or drug abuse habits. However, they are all stereotyped and classified into the same group regardless of their social backgrounds. Society has stigmatized them severely. The laws, in order to offset this stigmatizing created another factor that also added to the criminalization of the SMI.

Under the HIPAA Act, the government passed privacy laws restricting medical records. This has severely impaired the process of allowing this vital information to be recorded in the National Criminal Information System for firearms background checks. Thus the passage of the HIPAA Act basically thwarted this information to be made available to law enforcement or the licensed gun dealers that submit the forms for background checks.

Lawmakers must make a decision quickly how to handle the severely mentally ill persons within our community. The current process of sending them to jail or prison is not working and leaves one important fact in place. We would serve ourselves well to re-evaluate the way we deal with the mentally ill from beginning to end. It must make delicate decisions between the right of others and the rights of the SMI when it comes to treatment, incarceration or other preventive measures.

We must not take away someone’s freedom just because society doesn’t want to deal with the problem and thereby casting them into prisons with an out of sight, out of mind mentality. They are, after serving their time, released back into the community in a worst condition than when they were incarcerated. The cycle returns them to a life of crime, sometimes violent and they are returned to jail and eventually prison.

December 29, 2012

Published by permission of Carl ToersBijns 

Of The Impact: Retaliation. The Hearings Continue.

     As discussed in several recent articles, while hospitalized at The Arizona State Hospital, on September 06, 2011, I was unlawfully transferred from the one of the most peaceful patient units at ASH, the Palo Verde East unit, to the arguably most violent unit, Desert Sage East, precisely one business after a very well formulated 14 page grievance report had been submitted on my behalf by a representative of the state Office for Human Rights. As such, and consistent with my prior allegations specific to the inept and arguably criminal misconduct carried on by the Hospital's senior ranking medical staff, as well as in relation to the various representatives of the administrative offices responsible for meeting the obligations of any such public resource (both there at ASH as well as in the Arizona Department of Health/Behavioral Health Services Office of Grievances and Appeals), I found this action to be highly retaliatory, both at the time of the transfer itself, and increasingly so as the immediate first few weeks following the transfer transpired. As such, it quickly became clear to me that my immediate primary care physician (Dr. Pervais Ahkter) acted in complicity with the Hospital's chief medical officer (Dr. Steven Dingle) to willfully subject me to very dangerous residential conditions in order to try and impress upon me their bottom line willingness to do whatever they have to (had to at the time) when it comes to keeping someone like myself subordinate, fearful of their authority and in contexts such as this. 
     I had, (by then, 7 months into my 13 total months at ASH, been centrally involved in a formal state level investigation of staff rendered illicit substance trafficking there in main part of the Hospital itself, as well as provided the local media with an extensive body of information specific to the May, 2011, coverup of a violent patients' escape from ASH, a coverup that in time directly contributed to the brutal slaying of a young Phoenix woman named April Mott; I was also increasingly taking on the role of a patient advocate by this time, in terms of my own rights and treatment needs, and on behalf of my patient-peers, to whatever extent I could. (It should be noted that no patient has much opportunity to act on behalf of their peers at ASH, this as a matter of the twisted structure of the state's general policies relating to patient care in public facilities such as ASH. But I tried.) So, in effect, come early September, 2011, the experience of having a three paragraph letter, drafted and signed by Dingle as well as the Hospital's brand new chief executive officer, Cory ""crazycorycorner.weebly.com" Nelson, delivered to me by the Pakistani educated man, Ahkter, exactly 24 business hours following the above mentioned delivery of a formal grievance report, a letter informing me that I was to be moved whether I liked it or not from the one unit to the other, had the effect of being a political prisoner who had angered the executive staff of a third world country undergoing a coup. Bottom line. I knew not what I was experiencing, the felling of it at the time, that is, but it was intense, and only contemplation and reflection on the history underlying this period of time granted me full understanding of how extensively unjust these individuals actions were at the time. Unjust, mind you, and to hell with any concerns for my health, right? Those rat bastards treat each and every patient as though we are not patients at a hospital, in fact, but rather something along the lines of criminal, subhuman, or otherwise deserving of the worst treatment existent in America's contemporary health care system. Bottom line.  
    As already stated in previous articles, this past December 17, 2012, I represented myself on behalf of the ASH patient community in general (see Of Retaliation, Intimidation, and Criminal Abuses of Authority: The Hearings Continue, Dec. 07 and Dec. 19 2012, and Joel Rudd, assistant Arizona Attorney General, Dec. 20, 2012), in a hearing convened by the Arizona Office of Administrative Hearings, and as described therein, I faced an obvious pattern of tactical mischaracterizations specific to the factual details underlying this matter, including an untruthful body of testimony provided by Dr. Steven Dingle (via affidavit, with no opportunity for me to cross examine his testimony), and the blatantly self serving attitude of an Arizona Assistant Attorney General named Joel "the mortician" Rudd, who- as a matter of trying to reject certain aspects my testimony-  chose to demean the significance of the tragic death of the young Phoenix woman mentioned above. As always, the Machiavellian evil that I witnessed on virtually every goddamn day I was hospitalized at ASH reared its twisted head in classic fashion and tore into my good faith attempt(s) to speak out in defense of the rights and treatment needs of the ASH patients. Frightening stuff, indeed, and as stated, I still harbor great worry for my former patient-peers at ASH, because it is as clear as can be that the conditions at ASH are still dismally substandard as they were when I was there, from early January, 2011, to late February, 2012. 

      Central to the underlying story in this context, whereby senior clinical staff at ASH (Dingle) and at least one executive member of the administrative staff (CEO Cory "crazycorycorner.weebly.com" Nelson) ignored my plea to remain safe and free of the trauma of being immersed in a crowd of patients whose behavioral characteristics reflect a range of violent and related aberrant behavior, and instead, forcibly relocated me in defiance of applicable hospital rules and state and federal law specific to such actions, I was indeed subjected to immediate damage, both physical and psychological/emotional following that  transfer to the Desert Sage East unit, including at least one event wherein a staff charge nurse literally instigated and encouraged certain patients to attack me one particularly traumatic evening. It was insane (no pun intended), the glaringly stark differences in the atmosphere of these two patient units, and it was only a matter of hours before I sensed the message intended by the new who implemented the transfer itself: 
      
        "You asked for this, and now you will pay the consequences."

     
     And as time passed over a period of five full months, I was repeatedly assaulted, threatened, and otherwise subjected to the full brunt of ASH senior staff's willingness to ignore their most fundamental obligations and responsibilities as health care providers and state employed administrators, at times to such an extent that I found myself afraid to reenter Desert Sage East each day, this following the various therapeutic activities that I engaged in throughout the rest of the Hospital campus on any given day. It was as terrifying a period of time that I can imagine going through, the fear of not even being able to enter your own place of residence without being attacked, threatened, or otherwise traumatized; but truth be known, I was subjected to conditions of this nature when I was a child, and due to this issue, the worst underlying effects of that childhood abuse arose again in 2011, when this transfer occurred, leading me to experience an ongoing tirade of very disturbing dreams, panic attacks, and other like episodes consistent with post-traumatic stress, etc. Take a moment, then, to consider the fact that shit  occurred in a hospital. A mental hospital, at that, obligated to care for the treatment needs of someone just like me, and the other seriously mentally disabled patients at ASH. 
     But that's how it is at ASH. Surreal, and in no way consistent with the expectations that any reasonably minded citizen of our nation possesses in terms of medical care.    
     Needless to say, imposing such trauma on any patient, in any hospital or other like public facility, is in gross contradiction to established health care ethics, not to mention clearly mandated protections afforded to any American requesting services provided by a state entity such as ASH (and the Arizona Department of Health Services) by a host of very critical federal laws and policy. But to date, I have been exposed to a staff that for some goddamn reason doesn't believe such standards apply to them, a condition that I find utterly unacceptable, and I know that I am not alone in this thinking.  

     THAT SAID: On Monday, January 07, 2012, I will again be representing myself in specific relation to this issue- and again, on behalf of the ASH patient community in general, because my experiences at ASH are in no unique- in a hearing convened by the Arizona Office of Administrative Hearings in downtown Phoenix. At that time, I will be presenting my allegations in as formidably clarifying a manner as I can muster via my accrued evidential materials and via my well documented recollections, and again, I will be doing so in contest with the state of Arizona's most powerful law firm, The Office of Arizona Attorney General, and the weaselly little man known to many as "the mortician", a man who has become somewhat of a nemesis, Joel Rudd. It is an insult to me and my familial background to even have to share a room with someone like this rat, but it has to be done.

paoloreed@gmail.com








   

which my referring physician specifically requested I be treated on in accordance my behavioral characteristics, underlying diagnosis, and fundamental treatment needs   

Patient Abuse Is Tragic: A Call to Action. To friends and foes alike (for it matters not, if you are willing to help).                                                                                  The following was passed my way by the good folks at The David Balezon Center for Mental Health Law in New York City. Please take a moment or three to consider the information below, and if you can, participate in the process to the best of your ability.  The Bazelon Center for Mental Health Law www.bazelon.org/ Legal advocacy for the civil rights and human dignity of people with mental disability. December 20, 2012 -- The U.S. Department of Health and Human Services (HHS) has proposed a rule outlining standards related to development and coverage of essential health benefits (EHBs) under the Affordable Care Act (ACA). Per the ACA, all new health insurance plans offered in the small group and individual markets are required to offer a package of essential health benefits, including mental health and substance use disorder services at parity (i.e., on par with other surgical/medical benefits), beginning in 2014. However, many of the proposed rule's protections for insurance consumers and beneficiaries with mental illnesses could be much stronger.   Thus, we strongly encourage organizations and individuals to submit comments on the proposed rule before the deadline: 5 p.m. (Eastern Standard Time), December 26, 2012.   Click here to submit your comments to HHS online. You may also go to www.regulations.gov and enter "CMS-9980-P" in the search box in the upper-right-hand corner. When you see the proposed rule, click "Comment Now" and follow the instructions to submit your comments. Major points to include in your letter to HHS:  Applaud HHS for acknowledging the application of the Mental Health Parity and Addiction Equity Act (MHPAEA) to EHB plans. Urge HHS to clarify and provide additional guidance on the application of MHPAEA to EHB-benchmark plans.  The ACA prohibits health plan issuers from designing EHB-benchmarks in a way that discriminates against individuals based on disability. Strongly encourage the federal government to play a significant role in establishing and enforcing the ACA's nondiscrimination provisions. Recommend the development of a strong nondiscrimination standard that should be used to determine if coverage complies with the nondiscrimination requirements of the law. This includes ensuring that plans do not make coverage decisions or establish reimbursement rates that result in people with mental illnesses being needlessly served in segregated settings.  Encourage HHS to reassess the EHB selection approach critically in advance of the 2016 plan year and strongly urge HHS to adopt a comprehensive national EHB at that time. Urge HHS to describe the criteria by which the current approach will be evaluated. The proposed rule requires that a state selected benchmark plan that is missing an entire category of EHB must be supplemented by lifting the whole missing category from another benchmark plan option. The rule does not, however, provide a process for supplementing plans that provide only minimal coverage. Urge HHS to define a standard of adequacy that requires coverage of certain benefits in each category. If a base-benchmark does not include those benefits in a benefit category, urge HHS to require that the benefits in that category be supplemented to bring it into compliance. See the Bazelon Center's recommendations here on mental health services that should be included. Urge HHS to clarify that the mere inclusion of any service in a category of EHB does not meet the EHB consumer protection requirements of the law. The final rule should clarify that EHB must include sufficient services in each category to meet federal requirements, including: (1) that mental health and substance use disorder services be provided at parity with medical services in each category, (2) that coverage decisions, reimbursement rates, and benefit design not discriminate based on disability, and (3) that EHB take into account the health care needs of persons with disabilities. Urge HHS to clarify that the EHB must cover all of the benefits within categories that list more than one benefit, such as "mental health and substance use disorder services," in order to satisfy EHB requirements. The rule should state that plans are not EHB-compliant unless they cover both mental health services and substance use disorder services, as opposed to only covering, for example, substance use disorder services. Urge HHS to reconsider allowing plans to define habilitation services. Urge HHS to develop careful standards governing flexibility to substitute benefits within categories. Standards should ensure that plans cannot use this flexibility to avoid serving higher-risk beneficiaries. Recommend that HHS adopt the Medicare Part D standard as the standard for prescription drugs in the EHB-benchmark.  Medicare Part D requires "all or substantially all" medications in six categories including those most relevant to individuals with serious mental illnesses: antidepressants, antipsychotics and anticonvulsants. Strongly support the proposal to consider as essential health benefits all state-required benefits enacted on or before December 31, 2011.  Resources  HHS has specifically requested comments from state advocates on all possible EHB plans each state can select, as well as combinations of plans that a state can use to supplement missing benefits. Information on each state's proposed EHB benchmark plan and links to proposed benefits are available here. Access a list of states' three largest small group planshere. Also, see the health reform section of the Bazelon Center website. Thank you! IN CLOSING: As always, there is work to be done on all fronts when it comes to addressing the endemic shortcomings of America's very fabric in terms of our nations' most seriously mentally ill citizens. As only the most tragic events on our soil can seemingly state, there is a crisis at hand, and in the context of the mentally ill, I attest to the fact that in places like Arizona- and despite extensive funding sources and related laws and policy specific to the public health care system in general- the finger can be directly pointed at the graphic failings of the various mental health care professionals and related state officials who we, the public, have granted our trust in when in comes to caring for and treating this exclusive population. Please do you part today to see that these matters are addressed, with specific respect for the tragedy befalling the citizens being treated at The Arizona State Hospital, because Patient Abuse is Tragic in all senses of the term. The administrators and senior clinicians at ASH and throughout the Arizona Department of Health Services/Behavioral Health Services are still maintaining the substandard mental-medical conditions and practices, and they are getting away with it lock-stock-and barrel. paoloreed@gmail.com

Joel Rudd, assistant Arizona Attorney General. As to his perspective on tragedies relating to The Arizona State Hospital.

(This is rerun/updated article originally published in June, 2012.) 

    As discussed at length in several previous articles (see A Modern Horror Story: Wherein the Administrators of the Arizona State Hospital Willfully Put the Safety of the Greater Phoenix, AZ, Community at Risk In Order to Avoid Scrutiny, Leading to the Brutal Murder of a Citizen, April 05, 2012), and as reported in a four page feature news paper article (see Phoenix victim's family questions why man was free. "Mental hospital halted search; escapee now a murder suspect.", by JJ Hensley, Arizona Republic [newspaper], Sept. 27, 2011), a young Phoenix woman named April Mott was brutally beaten unconscious and stabbed to death in late August, 2011, by a man who had violently escaped from The Arizona State Hospital three months earlier. That escape was never reported to the public by ASH, in direct defiance of the facility's express duty to the public, a deliberate action designed to avoid scrutiny and accountability and which directly contributed this tragedy. For, in the subsequent months of June, July, and early August, the killer had literally been running amok in the greater Phoenix metropolitan district, but when in custody of phoenix police on at least 3 occasions, the authorities had no idea about the fact that he had violently escaped from ASH in late May. Had the administrators and senior clinicians at ASH merely issued a clear report to the effect that a violent mentally ill man was at large in the Phoenix area, the late August murder of April Mott would not have occurred. Bottom line.  

     April Mott was a beautiful, kind, and 100% innocent bystander of sorts to the details of this tragedy, with a loving family and many friends. All bystanders, in effect, until the day that April was murdered. At that point in time, her life was horrifically introduced to the criminally substandard conditions at ASH, and the related incompetence of ASH's administrators (including the interim hospital supervisor at the time, Ann Froio, and ASH Chief Operating Officer, Donna Noriega) and senior clinicians (including former ASH Chief Medical Officer Dr. Steven Dingle); as well as any other officials of ASH who are directly involved with such affairs, such as Joel "the mortician- Prince of darkness" Rudd, ASH's representative legal advisor and staff member of The Office of the Arizona Attorney General.

      At one point in this past Monday, December 17, 2012, legal hearing (see Of Retaliation, Intimidation, and Criminal Abuses of Authority: The Hearings Continue, December 07, 2012, and An Update, December 18, 2012), I referred to the above described tragedy in citing the motivations of ASH administrators to utilize highly unlawful methods of intimidation and coercion in order to forcefully manipulate patient behavior, including direct retaliation imparted on patients who exercise their lawful right to report staff misconduct. In the above legal hearing, I explained  to the assigned judge that I had in fact reported both the escape described above as well as its connection to the killing of April Mott to the reporter, JJ Hensley, who published the newspaper article I mention (above); and the simple fact that I was subsequently subjected to overtly clear retaliation, including but not limited to an unlawful transfer from the most peaceful unit ASH to one of the most violent, where I was consequently subjected to ongoing violence that at times was imparted on me by staff themselves. The transfer itself was forced on me against my express wishes, and was not implemented in accordance with hospital policy, under the direct authority of then ASH Chief Medical Officer Dr. Steven Dingle  and former ASH CEO Cory Nelson (both of them signed the formal document ordering the transfer, an order that again, occurred in patent contradiction to hospital protocol.) It was clear to me that the transfer occurred in order to cow me into silence as an outspoken critic of staff misconduct and administrative wrongdoing, and I emphasized this to the judge at that time.

     In response to my testimony in this context, with direct respect for the brutal death of April Mott and the willingness of Hospital administrators to conceal the escape of murderer Jesus Rincon Murietta, Joel "the mortician- Prince of darkness" Rudd stated the following:

          "You testify that because of this man having escaped from ASH in late May, 2011, a 'bad thing' happened. Is this correct?"
   

     I could hardly believe what I was hearing at the time, this astoundingly crude debasement of April Mott's death. A bad thing? What a Bastard! Referring to the tragic loss of this young woman, and the impacts of her brutal death on her loved ones and friends, as a bad thing…. The plain fact of the matter stands, that if ASH administrators had merely granted the public- including Phoenix police, etc.- fundamental knowledge to the effect that a very dangerous and known to be seriously mentally ill man was at large in the greater Phoenix metropolitan district, April Mott would be alive today. It is clear that Rudd has no regard for the wellbeing of the public, which flies in the face of his explicit responsibilities as a member of Arizona's state funded legal authority, the Office of the Attorney General.

     Believe me, I felt more than a twinge of anger at these words- a bad thing- for as per my own legal training, I recognized the simple fact that Rudd was willfully downplaying the significance of this tragedy in order to methodically condone the criminal practices of his client, the Arizona Department of Health/Behavioral Health Services and the staff of their subordinate facility, The Arizona State Hospital. Rudd, a highly paid public legal professional charged with the responsibility of seeing that Arizona's citizens as a whole are provided with the full protections afforded by every law in the book; and his client(s), the public employees of ADHS and the staff at ASH. As I see it, they are all representative of America's most perverted discord, and I cannot say strongly enough how critical it is today, with the Newtown tragedy still simmering on the forefront of our national conscience, for we as a people to stand up against these forms of corruption and administrative misconduct.  

     At that point in time when I heard Rudd's statement, had I been feeling more surly and or otherwise less civil in my behavior, I would have immediately drawn the courts' attention to the tragedy that befell the citizens of Newtown, Connecticut. For one has to wonder: How might have Rudd characterized the murders of 27 innocent persons were the defendant his client? As a "worse bad thing"….?

      The cold hearted characteristics of Joel "the mortician- Prince of darkness" Rudd was overwhelmingly evident to me at the time (yet again), and my stomach fairly well turned as I was reminded as well of the equally cruel conduct of various ASH staff who I had the distinct misfortune of having to interact with during my thirteen full months of hospitalization at ASH, including but not limited to primary attending psychiatrists such as Dr. Pervaiz Ahkter, Dr. Sylvia Dy, and Dr. Ruby Ramos-Roxas, and numerous ASH nurses and technicians (orderlies, they know who they are….). 

     To date, the ASH administrators and senior clinicians most centrally involved in this matter have not been held accountable in any sense of term, and each and every one of them is still drawing high salary paychecks provided to them by the public payroll system. Dr. Steven Dingle, as a matter of fact, was promoted to a higher position of responsibility within the Arizona Department of Health Services system, and in the last two hearings that that I have been involved with in the AZ Office of Administrative Hearings, his testimony has been deemed factual and accepted as truth in the form of affidavits, with little to no consideration for my request(s) to be granted the opportunity to cross examine him. It is a sham, through and through. Only in Arizona, further personified. To view the full in-line Arizona Republic article about the April Mott killing, see: 

http://www.azcentral.com/community/phoenix/articles/2011/09/27/20110927phoenix-victims-family-questions-jesus-murrieta-free-april-mott.html

(UPDATE SEPTEMBER 2014: Not only was Dingle granted a major promotion under the authority of ADHS Director Will Humble.... No, it gets even worse, for during the period 2012-2013, both  Cory Nelson and Donna Noriega were also bumped farther up the proverbial food chain, in graphic defiance of the established history specific to their utter lack of ethos, abject ineptitude, and associated criminality as supervisors of the ASH operation when these events going down. Under the equally inept authority of Humble), former ASH CEO Nelson is now the Deputy Director of the entire Arizona Behavioral Health Services network, while former ASH Chief Operating Officer Noriega is now ASH's CEO! IT IS THAT BAD, AND THEY ARE STILL GETTING AWAY WITH IT. ALL OF THEM.)  

    IN CLOSING: l have heard from and am now in contact with an actual patient at ASH, a man who I had never met until now, but who has struck me as a very nice and reasonably intelligent man. I am constantly thinking about my former patient-peers at ASH, many of whom I sincerely miss, and I most definitely worry about the crisis at ASH. In terms of this new contact, I am going to do what I can to see that his needs are met in an optimum manner; and while I obviously cannot divulge anything more specific about this communication, in large part due to the very real peril that I would put this patient in were ASH staff to learn that he is in communication with me at this time, I can state that he has several very serious concerns about specific issues at ASH and that he shares my willingness to see that the matters are addressed in accordance with established law and policy. It- this first contact from within the hospital itself- is the beginning of something very special, I feel, as my work slowly but surely advances and the exposure of the substandard mental-medical conditions and practices at ASH broadens. 

Yesterday I posted a a new listing of resources and contact information specific to the affairs of The Arizona State Hospital, and I strongly encourage anybody of like mind to do whatever you feel comfortable with in terms of defending the dignity and rights of the patient community at ASH. The administrators and clinicians at ASH are maintaining that operation at a dismally substandard level of medical care and practice, and they are getting away with lock-stock-and barrel. Patient abuse is highly illegal and when it comes the care needs of the highly vulnerable, seriously mentally disabled patients at ASH, it is sickening to the core. Let's work together and see that this matter is resolved today. I welcome any and all contacts and want to extend my sincere thanks to those of you who I have come to know thus far through my writings, and I really appreciate your willingness to consider my concerns in this context.     

paoloreed@gmail.com

An Update. Of Retaliation, Intimidation, and Criminal Abuses of Authority: The Hearings Continue

     Monday mornings hearing specific to my concerns about the administrative and senior clinicians at The Arizona State Hospitals willingness to employ highly illegal methods of intimidation and coercion, including graphic forms of retaliation, as a matter of doing all they can to suppress any ASH patients'  voice when such a patient chooses to exercise there right to report staff misconduct and abuse, took close to three full hours. During that period of time, I did my best to submit a seemingly formidable body of clear evidence in support of my concerns, including but not limited to statutory evidence flowing from state and federal law, my own testimony, and various hard copy documents that I collected and kept intact as the issues underlying this case played out, late summer and early fall, 2011.   

       Specifically, on September 02, 2011, a very serious grievance document prepared on my behalf the then senior advocate of The Arizona Department of Health Services/Behavioral Health Services was submitted by that person to the administrative offices at ASH, and one business day later, I was informed that I was going to be transferred from the most peaceful residential treatment unit at ASH (a unit that my referring psychiatrist had specifically requested I be placed on in keeping with my known behavioral characteristic as nonviolent person affected by childhood trauma specific to psychological and emotional abuse) to one of the most violent units. 

     I knew at the time that my safety was being put into immediate jeopardy, and I made this clear at the time. I did not agree to the transfer at the time, but could not do much about it, and instead just did what I could to establish a record specific to the matter. Within days of being transferred to the new unit, I began experiencing a wide range of violence, including but not limited to physical assaults imparted on me by other patients who staff had effectively encouraged to from resentment towards me; and in one specific event, a staff nurse literally stated to the other patients as whole: "Do you see this guy?! He is out to make trouble for all of us! Do you see him, do you?!", and within seconds, a group of highly unstable patients assailed me with threats to my life and at least one actual assaultive strike to my upper body. With the unlawful implementation of this transfer began what I now identify as the most intensively damaging period of time that I experienced during my 13 full months at ASH, and it all came about due to the administrative staff at ASH's willingness to put any patients' established care needs aside in order to preserve the substandard conditions at ASH and avoid the due accountability that I know they have coming to them. Today I am markedly affected by the residual impacts the duress that I experienced after that point in time, and my ongoing psychological treatment has now come to include addressing the very real trauma that I experienced in this context. This is known as HARM in a legal context, very real harm and damage that come about in my case as an ASH patient, and which I contend comes about as a matter of standard malpractice at ASH in terms of any seriously mentally ill patient currently being treated there.             
     It will take upwards of 6-10 weeks before the final conclusive materials are released specific to Mondays hearing. Meanwhile, in early January, I will again be representing myself on behalf of the patient community at ASH in another hearing at the AZ Office of Administrative Hearings, again with the specific intent to create a record, in specific regard to the violence that I was exposed to following the unlawful transfer discussed above, and the related harm that I suffered due the failings of ASH's administrators and their willingness to put their own selfish interests (as criminals, in my well founded opinion) in front of those of the highly vulnerable and disabled patients in their care at ASH.     

       What a great time this is to get on board with this cause. A moderately deep increase in cash flow to the needs of Arizona's mental heath clients in the outpatient community came about in recent months, and the attorney generals' office is taking quite a bit of heat in relation to their own lawlessness right now. A great time, indeed, for anyone with a sense of conscience to do their part in fighting the abuse of patients at The Arizona State Hospital, and beyond. Please, get involved, take action, help make a difference today. 

paoloreed@gmail.com