Open Letter and Report. RE: The Brutal Murder of a Young Phoenix Woman and the Related Criminality of Administrators and Senior Clinical Staff at The Arizona State Hospital. 

In fall, 2012, I submitted the following letter to the editorial staff at the Arizona Republic newspaper. I did so in good faith, and with the fundamental support of Republic reporter J.J. Hensley, who I knew via the reporting of Jesus Rincon Murietta's violent escape from the Arizona State Hospital in late May, 2011, which ASH administrators and senior clinicians willfully covered up in blatant defiance of their required obligations, thus leading to the related death of April Mott. But the editors at the newspaper rejected my request to publish the letter on the basis of "sensitivity". Needless to say, my disappointment was not based upon surprise, for I have learned the hard way that any mentally ill person's willingness to participate in public discourse will most often meet nothing short of absolute rejection. This arises, of course, due to the endemic presence of societal stigmatizations  relating to all/any persons affected by mental illness, and the related discriminations that have long been at the root of patient abuse in facilities such as ASH.

Oct. 19, 2012

To: Editor, The Arizona Republic. Phoenix, AZ.  

From: ---------------, aka PJ Reed, author. "The Arizona State Hospital and Patient Abuse."

Introduction

      My name is ---------------. I am a 51 year old seriously mentally disabled man diagnosed and affected by major depressive disorder and associated traits. Cognitively speaking, my particular disability is not as pronouncedly challenging to me as the affects of serious mental illness is for many of my peers in the mental health community, including my many former patient-peers at The Arizona State Hospital; as such, I can generally control the most severe effects of my mental condition through low dosage drug therapy (anti-depressant medication), and am able to remain rational and feel reasoned in terms of my day to day life activities. I was initially diagnosed with major depressive disorder in spring, 2010, and following eight months of hospitalization in Tucson area mental health facilities, I was referred and admitted to The Arizona State Hospital (ASH) via a cooperative civil court order on January 11, 2011. 

     ASH is a public entity under state and federal law, and as such, is licensed in accordance with very specific edicts of law and policy, as well as subject to provisions of state and federal law that flow from established human and constitutional rights, as found in protections provided by the Americans With Disabilities Act, for example. Central to these provisions is the notion of a public trust, and the required obligations of state employees to abide by that trust. I remained at ASH for a total of thirteen (13) full months, and discharged from there on February 21, 2012. I am a nonviolent man with a very limited criminal record (misdemeanor DUI in 1999), and I am well educated (including a partial legal education in good standing). I only mention these facts in order to dispel any possible stigma that might arise in relation to my acknowledged mental disability. Seriously mentally ill adults and children are one of America's most marginalized populations, and all of the patients at The Arizona State Hospital are seriously mentally ill.  

Background

     In late May, 2011, at around 9:30 p.m., a 20 year old male patient at The Arizona State Hospital (ASH) named Jesus Rincon Murietta managed to tear the electronic identification and pass card from an ASH staff's neck, which he then used to force his way through at least three electronically secure and locked doorways, ultimately gaining his way to the exterior area of the main ASH facility (the main parking lot), where he evaded several pursuing security guards by throwing baseball size rocks at them, which threatened the guards' safety to such an extent that they cut the pursuit short, allowing Murietta to escape the ASH facility and enter the greater Phoenix community. I was, at the time, hospitalized in the same section of ASH that Murietta was hospitalized in, and when I learned of the incident, I immediately had three very serious concerns: 

     A) That Murietta was at risk of harm to himself (it was known that he had previously attempted to kill himself 

          on at least one occasion);  

     B) as well as in relation to the safety of the greater public (he was also known to be violent, at times); 

     C) and that to my knowledge at that point in time, ASH's administrative staff had failed to report the escape, which I deemed      

          to be a clear breach of the public trust, wherein ASH administrators put their own interests ahead of the those of the    

          public. 

     Based on the these specific concerns, on June 03, 2011, I placed a call to the news desk of The Arizona Republic newspaper and reported Murietta's escape. I was put in touch with reporter JJ Hensley within 36 hours of my first contact with the AZ Republic news desk, and I shared all that I knew about the matter with him at that time. Subsequent to our conversation, when JJ Hensley contacted ASH's administrative staff about this matter, they refused to acknowledge any information specific to Murietta's escape, and on the basis of patient privacy standards, they also refused to acknowledge that Murietta had ever been hospitalized at ASH. They also went so far, in fact (this as per JJ Hensley's accounting of this at the time), as to deny the occurrence of any escapes whatsoever in recent history; and because of this, JJ Hensley was unable to confirm my report, and thus, unable to publish a report of his own in the form of a news article alerting the public of the escape. Murietta, consequently, was never apprehended in specific relation to his having violently escaped from ASH, which effectively allowed him to run free in the greater Phoenix community for the entirety of the summer, 2011, with no regard or concern as to his safety as a seriously mentally disabled man, or with respect for the safety of the greater public.      

     Between early June and late August, 2011, (as reported three months later in JJ Hensley's article [cited below]), Phoenix police did arrest Murietta on more than one occasion in relation to criminal conduct (that included assault and battery and auto theft), but the police had no idea that he was a recent violent escapee from the Arizona State Hospital, which is a public mental health care facility operated under the authority of Arizona Department of Health/Behavioral Health Services. Will Humble is director of ADHS, and at the time of this occurrence, had direct authority over the fact that the escape was not reported. Had police known of the escape, they would have taken action to either place Murietta back into one of several Phoenix area acute psychiatric facilities (including ASH), or they would have kept him in custody with direct respect for the fact that he was a violent  escapee from ASH (the escape itself involved several violent criminal actions, such as assault and theft of the ASH staff person's identification, and aggravated assault on ASH security staff when they were in pursuit of him in the parking lot and he was throwing rocks at them). But due to ASH administrations' failure to report the escape when it occurred, and their related refusal to provide the public with information about Murietta's escape when JJ Hensley sought that information in early June, police released Murietta on each of these occasions. Herein, the cycle of violence continued, not due to any failures of the Phoenix police, but to those of the senior clinical and administrative staff at ASH.    

Discussion

     On August 27, 2011, a female ASH security guard named Blanca informed me that Jesus Rincon Murietta had been arrested in relation to the stabbing and killing of a young Phoenix woman named April Mott. The security guard shared this information with me because she was aware that Murietta and I were acquaintances (we were both in treatment together in Tucson area hospitals in 2010, before being referred and transferred to ASH). I then recontacted the news desk at The Arizona Republic newspaper, and updated my earlier communications with them with specific reference to the fact that the man whom ASH's administrative staff had denied having escaped from ASH in late May, 2011, was now on their front page, this with respect for his role in April Mott's death. I was again put in touch with JJ Hensley. I filled him in as best I could from there in the hospital, and he in turn, revived his investigation into the Murietta affair as it now stood, with immediate respect for the murder of April Mott.  At that time, JJ Hensley spoke to the newly hired ASH Chief Executive Officer, Cory Nelson, who had taken over the leadership of ASH on August 1, 2011. Nelson formally advised JJ Hensley in at least one conversation that ASH was not required to have reported Murietta's very real escape from ASH in late May, 2011, on the grounds that Murietta's status as a voluntary  patient at this time required ASH  administration to protect Murietta's privacy, rather than to issue a dutiful good faith report of the escape on behalf of public safety and/or Murietta's safety. Nelson went further at that time in declaring that while he could not speak in specific terms about any one patients treatment at ASH, a general rule applies to all voluntary ASH patients which grants them the right to leave at ASH at anytime they choose to (and, it follows [as per this particular case], in any fashion they choose). Subsequent to this conversation(s), JJ Hensley published a very in-depth and well written investigative report about this matter on September 29, 2011. ("Victims Family Questions Why Man Was Free" JJ Hensley, AZ Republic Sept. 29, 2011). 

    

In that article, ASH supervisor Cory Nelson is quoted as follows:     

    

State hospital CEO Cory Nelson, who started Aug. 1, said he could not talk specifically about the Murrieta case. But in general, Nelson said, the hospital's obligation to report patients who leave against the advice of doctors extends only to those who are involuntarily committed.

  "If they (voluntary patients) choose to leave their treatment environment, that would be their choice," Nelson said. "If someone leaves the facility and they don't really have another attachment to another person . . . we contact law enforcement and let them know that the individual has left the hospital."

     Much more recently, on September 23, 2012, Mary Reinhart of The Arizona Republic newspaper published a Questions and Answers session-article documenting an interview with ASH Supervisor Cory Nelson. In this article, Nelson was asked to comment on the two 2011 patient escapes that occurred in relation to ASH's function as Arizona's only long term public mental health facility; and in responding, Nelson alluded to the late May, 2011, escape of Jesus Rincon Murietta, by again declaring that voluntary patients are effectively able "walk out" of ASH with no obvious or apparent restrictions whatsoever, but rather as a matter of "privilege" that- in Nelson's opinion- arise in relation to the voluntary patients "civil rights." 

Nelson's Sept. 23, 2012, response in this context to AZ Republic reporter, Mary Reinhart, are shown below:  

"We have individuals who are in the facility, very rare but we have them, who are there on a voluntary basis and they can walk out (of ASH) on a voluntary basis. This is one of the privileges that you have when you're voluntarily accessing services. We can't impinge on their civil rights."

     Contrary to ASH supervisor Cory Nelson's interpretations of applicable law and policy and his related statement in this matter, the following Arizona Revised Statute, Title 36- Public Health and Safety- 531 Evaluation; possible dispositions; release, very clearly dictates that no such hospital facility is to release/discharge a voluntary patient until such a time as that patient, at a minimum, has been the subject of a formal mental health examination-evaluation and assessment with specific and undeniable concern for the safety of both the patient, as well as that of the greater public. As follows:   

Arizona Revised Statute Title 36- Public Health and Safety- Provision 531: Evaluation; possible dispositions; release.

A. A person being evaluated on an inpatient basis in an evaluation agency shall be released if, in the opinion of the medical director of the agency, further evaluation is not appropriate unless the person makes application for further care and treatment on a voluntary basis. 

B. If it is determined upon an evaluation of the patient's condition that he is, as a result of a mental disorder, a danger to self or to others, is persistently or acutely disabled or is gravely disabled, the medical director in charge of the agency which provided the evaluation shall, unless the person makes application for further care and treatment on a voluntary basis, prepare, sign and file a petition for court-ordered treatment unless the county attorney performs the functions of preparing, signing or filing the petition as provided in subsection C of this section.

C.The agency may contact the county attorney to obtain his assistance in preparing the petition for court-ordered treatment, and the agency may request the advice and judgment of the county attorney in reaching a decision as to whether court-ordered treatment is justified.

Reasoning.

     Cory Nelson's statement that voluntary patients "can walk out" of The Arizona State Hospital "on a voluntary basis" is ludicrous in all senses. I attest to this fact, for in my own case (as a voluntary patient at ASH), I could not have been granted discharge until my primary care physician(s) had clearly established- via a very specific protocol- that I was no longer posing a risk to myself in terms of suicidal ideation, and other like details specific to my diagnosis. Herein, it is clear that the administrators of the Arizona State Hospital made a critical error (at best) when they determined that they were not required to report Jesus Rincon Muriettta's escape in late May, 2011, an error that directly contributed to the death of April Mott. It is important to note that at the time of Murietta's May, 2011, escape, and well into the summer, there was no duly hired supervisor at office at ASH (John Cooper left his position as ASH's supervise in April, 2011, and Cory Nelson was not hired until August, 2011); under those circumstances and a period of at least four full months, the primary administration of ASH was being managed by the facility's chief operating officer, Donna Noriega, chief medical officer, Dr. Stephen Dingle, in active cooperation with ASH's long standing legal counsel, assistant Arizona Attorney General, Joel Rudd.

     I contend that each one of those individuals, at a minimum, along with Jesus Murietta's attending psychiatrist, Dr. Stephen Morris, were fully aware of the fact that their failure to report the escape amounted to an unlawful cover up the factual details specific to the escape, which I further contend occurred in graphic violation of the public trust, medical ethos, and myriad other dynamics relating to this matter as a whole.  ARS 36-351 dictates the fact that only after the administration of a formal evaluation specific to the mental state of any patient's release from an "evaluation facility" (such as ASH), and the issuance of a medical determination clarifying the patient's mental "condition" with very explicit concern for whether (or not) the patient is "a danger to self or to others." This requirement is critical in terms of a facility like ASH's role in relation to public safety, and is precisely why this specific provision of Title 36 (law) exists. No evidence has been provided by Cory Nelson supporting the notion that ASH clinicians had administered the required process of evaluation specific to Murietta's state of mind immediately prior to the time of his escape; nor has the medical director at ASH (Chief Medical Officer Dr. Steven Dingle) issued any clarification of Murietta's mental condition at that time.

     As stated, this bright line body of Arizona statutory law and policy specific to the subject of evaluation and possible disposition(s); release of any voluntary mental health patient, represents a critically fundamental area of information applicable to the function and responsibilities of each and every senior staff person at The Arizona State Hospital and its parent agency, the Arizona Department of Health Services, including but not limited to all licensed ASH clinicians and practitioners (including the chief medical officer, Dr. Steven DIngle, and Murietta's primary attending doctor, Dr. Morris), the Hospital's Chief Executive and Operations officers (Cory Nelson, Donna Noriega), as well as ASH/Arizona Department of Health Service Director Will Humble, and ASH's on-site legal representative, Mr. Joel Rudd, of The Arizona Office of the Attorney General. ARS Title 36- 351 is a body of information that is readily available via a range of easily accessible resources, so there is no reasonable explanation for why this lawful requirement would have been unfamiliar to ASH's senior clinicians (e.g., the medical director) at the time of Murietta's escape. While ARS 36-531 does not specifically dictate what a facility such as ASH must do when a patient escapes the facility in the manner that Murietta did, common sense dictates the simple fact that his violent escape from ASH and unlawful entry into the community posed an immediate threat of potentially grave harm to the public (including Murietta himself) and further belies the fact that ASH's executive staff should, in no uncertain terms, have reported Murietta's escape at the time it occurred in as loud a fashion as is reasonably possible. As already stated, there is no reasonable explanation for why ASH failed to exercise simple common sense in this matter.    

     By failing and refusing to report or provide any information about Murietta's escape when it occurred, including in early June, 2011, when they were directly asked about the escape by JJ Hensley, senior clinical staff and executive administrative staff at The Arizona State Hospital willfully contributed to the furtherance of a cycle of violence that began with the escape itself and culminated in the late August, 2011, slaying of an innocent young woman named April Mott. Given the availability of very clear and well established provisions of law and policy specific to the status of individuals such as Jesus Murietta at the time of his escape, it is of serious concern to me that several of ASH's highest ranking staff members willfully engaged in a pattern of deception and deceit in direct violation of their required obligations to the public. The only logical explanation for why the senior clinicians and executive staff at The Arizona State Hospital chose to not report Murietta's escape at the time it occurred is that these individuals intended- at the time- to avoid accountability and oversight specific to the series of events that underlie Jesus Murietta's actual escape. As such, they put their own arguably selfish interests ahead of those of the public, and consequently, a citizen died.
     This is unacceptable, even unconscionable. The fact is, if Murietta's escape had been reported, he would have been taken into custody and subjected to the minimum required standards specific to formally releasing him from confinement at ASH or some other like mental treatment and evaluation facility at some point prior to April Mott's death, which clearly would have altered the course of events that led to April Mott's death. As documented in JJ Hensley's September 29, 2011, article about this matter, Murietta was in fact arrested and then released by Phoenix police in relation to several relatively insignificant events on at least two occasions between the time of his late May, 2011, escape from ASH, and the  time of April Mott's death in late August, 2011; but as already stated, the police did not realize that Murietta was an escaped violent mental patient, simply because ASH senior staff failed to meet their obligations to the public in terms of reporting the escape at the time it happened. In no uncertain terms, this failure graphically contributed to a furtherance of the violence that began at that time, while a simple exercise of common sense consistent with applicable law and policy would have stopped the cycle before it escalated beyond the escape itself.      

     Likewise, ASH CEO Cory Nelson's statements to JJ Hensley (in September, 2011) and Mary Reinhart (on September 23, 2012) about the events surrounding Jesus Rincon Murietta's escape from ASH and the manner in which ASH's senior staff handled the matter are patently inaccurate, misleading, and as such, pose an ongoing undue risk to all Arizona citizens' safety and general well being, including each and every Arizona citizen currently undergoing residential treatment at the Arizona State Hospital. Simply stated, if Nelson and his staff are allowed to carry on the operation of Arizona's only long term public mental health facility while still adhering to utter misrepresentations of established law in matters of this sort,

there is no telling how long it will be before something of similar gravity occurs again, and more innocent people are harmed. This is an unacceptable and gross violation of the public trust afforded to these senior level, tax payer supported state employees in terms specific to their specific titles Responsible parties in this context include ASH supervisor Cory Nelson, Assistant Arizona Attorney General Joel Rudd, and any other employees of ASH directly related to this situation as it stands today. The good faith attempts of JJ Hensley and Mary Reinhart to acquire information that the citizens of Arizona have every right to be as fully and truthfully informed about as possible, and the related willingness of ASH administrative staff to misrepresent that information in defiance of applicable provisions of law, policy, and required practice(s) specific to these reporters' inquiries, illustrate the fact that there are very serious, identifiable problems with the operation of ASH at this time. Senior level staff are bound by their state contracts and the duties assigned to them therein to ensure that all ASH patients, who are all citizens of the state of Arizona, are provided with reasonably optimum care, treatment, and management of their affairs; such staff are equally bound in terms of their duties to the greater public, including but not limited to all taxpaying citizens of Arizona, and beyond.  

Conclusion    

     The problems associated with this matter are not at all unusual at ASH. That said, I attest to having witnessed and experienced, during the entirety of my thirteen (13) full months of hospitalization at The Arizona State Hospital (January 11, 2011- February 21, 2012), widespread and unregulated abuses of patient rights in a variety of forms, including verbal, physical, emotional, and psychological abuse, as well as clinical and administrative abuse of authority and directly related administrative negligence (including in direct relation to this same specific matter, as applicable to my specific status at ASH in late 2011 as a voluntary patient). I witnessed and experienced physical, emotional, and psychological abuse that was imparted by ASH staff at all levels of employ. This is not to say that there aren't any decent persons working at ASH, for there are, but such employees are the minority at ASH, and their ability to fully perform the duties affiliated with established standards of care is corrupted by endemically  embedded misbehavior that reflects the exact sort of wrongdoing that the Americans With Disabilities Act is designed to eliminate. In this context, the situation at ASH reflects well recognized shortcomings that have been common to state mental health care facilities since their creation in the 18th century.    

     Patient abuse of any kind is illegal, inhumane, and unconscionable. In my humble opinion as a former ASH patient, taxpayer-consumer, citizen, and human being, The Arizona State Hospital is being operated at a level of dismally substandard medical-mental health care and practice, and the one's most directly responsible for this reality are getting away with it. The factual truth(s) underlying the whole of this one particular matter, including but not limited to the brutal killing of April Mott, the specifically applicable provisions of ARS 36-351, and the misconduct/negligence of these trusted public servants in relation to this matter confirms my contention in this context. Across the board in any contemporary society, it is common knowledge that seriously mentally ill persons are at high risk of abuse and greatly vulnerable to exploitation and neglect, and the patients at The Arizona State Hospital are among Arizona's most at-risk and vulnerable adult population in this context. As such, the patients at ASH deserve heightened protection(s), as provided by the ADA and as afforded by notions of common decency; as well as nothing short of reasonably optimum care in accordance with established health care ethics. In the case of Jesus Rincon Murietta, who less than one week ago yesterday was convicted in a felony (murder) criminal proceeding specific to the death of April Mott, a seriously mentally ill man was unlawfully put at risk of harming himself or others (and is now facing life in prison) due to the failure of high ranking state employees to abide by law; and because of the afore described furtherance of this cycle of violence, a beautiful young woman- who, if not for this failure, would have had nothing to do with Jesus Rincon Murietta nor the graphic misconduct of these state employees in this context- is dead today. I beg of you, the citizens of Arizona, to take action today in order to see that the problems at The Arizona State Hospital that I have identified in this document are meaningfully addressed and corrected.    

By: PJ Reed, author: "The Arizona State Hospital and Patient Abuse"

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To date, none of the individuals directly involved in this horrific pattern of misconduct has been held accountable under the law. As such, they are all still employed by the state of Arizona, in positions including but not limited to medical practice, administrative representation (including legal representation at the highest level of state employ in that context), and other like roles by which we the citizens of Arizona are due nothing short of optimum professional conduct. They are all reasonably  educated and have been so employed at ASH and the department of health for many years, so there is excuse whatsoever for their misconduct why in this highly questionable matter. More importantly, in legal and ethical terms, there is absolutely no just cause underlying why this specific series of events occurred as it did, nor in terms of why the depraved misconduct of these individuals has never been addressed. They each need to be held accountable under the applicable law, and I see no reason for why any of them should be created the trust of Arizona's citizens, including the patients at ASH. I attest to my knowledge and related experiences in this given context, and as always, am willing to share my concerns in good faith, with the distinct hope that the patients as ASH be provided with reasonable health care and treatment. But at a minimum, until these sorts of persons are removed from their given positions of responsibility and authority at ASH and in the state health care construct, I know that this hope will not find fruition. 

It really is that bad. Grossly Substandard medical-mental health care, and they are still getting away with it. For now….. 

paoloreed@gmail.com