Thursday, October 18, 2012

Injustice of Jessica Fernandez, how the system failed her!



    
      On May 22nd of this year, Nancy Fernandez received a text message from her daughter Jessica, saying that she would not have to worry about her anymore. Because she previously attempted to end her life, Nancy immediately called the Erie County Sheriff’s department. Shortly thereafter, she and her husband David heard sirens, and they were aware that there was a strong possibility that it was the result of that call. Though they feared the worst, nothing could prepare them for what ultimately occurred.     
      The bedroom has not changed in the ensuing months since that day last May. Medals, awards and pictures adorn the walls and as if it awaits a young woman who is about to return from summer camp or a trip abroad. Tragically, that is not the case, because the sirens her parents heard were indeed for their daughter. It was then that they were informed that their daughter Jessica, a 16 year old young lady, ended her struggle with bipolar disorder by standing in front of a moving train in Vermillion. Besides two loving parents, she left behind many other family members, and friends who still miss her terribly. She also left behind many unanswered questions.
     As visitors walk through the family home, so many pictures of Jessica as a happy, vibrant youth, so full of promise are visible. It is then that one must ask, what could have gone so terribly wrong to lead to such a tragic outcome. As her story unfolds, it is painfully obvious that the main culprit is a failure of the medical community to provide her with the proper care, and give her the opportunity to live a long, happy life. Hospitals, clinics, treatment facilities, who continuously fail to recognize the complexities of this silent killer, did not take the necessary steps to ensure her recovery.
     The story begins about a year and a half before this tragedy when she began to experience some depressive episodes. It was at this time that she received a misdiagnosis of depression and anxiety. Since bipolar disorder is routinely misdiagnosed, this began an odyssey for her through the mental health “maze” that has left her parents “pissed off at the system!” In reality, they echo the feelings of many parents, and loved ones, who have battled to negotiate a fragmented and woefully underfunded system. It is one that routinely fails those afflicted with these invisible killers.
     As people reflect back to the last 12 months of her life, it is shocking to discover that Jessica was hospitalized 10 times. Additionally, the number would have been higher had some hospitals been able to find a treatment facility for her, because on at least three other occasions, she was taken to the emergency room and immediately discharged. Laurelwood, Elyria Memorial, and Fairview hospitals all became complicit in her failed attempts at being provided the necessary treatment. The State of Ohio, which has drastically reduced the number of beds available to those in need, should be included for their adversarial sanctions towards people like Jessica.
     What David and Nancy Fernandez discovered is something that few people outside the mental health system understand. They, like others, are stunned to discover the medical profession’s lack of benevolence when confronted with these disorders. Shockingly, hospitals are not required to treat people with mental illness, only to make them stable enough for discharge. That is if the patient is even admitted! To better illustrate the absurdity of that process, imagine the outcry if someone with considerable chest pains arrives at an ER. At that time, rather than treat the individual, the hospital hands the patient some pills, then instructs them to seek treatment elsewhere because a bed is not available for them.
     This nomadic trek from hospital to hospital is a typical pattern that plays out daily for those afflicted. It is one that breaks down hope, and leaves the patients crying out for someone to help them. It is one that leaves parents like David and Nancy searching for answers as to how this could have occurred.
     One glaring problem in her treatment was that it does not appear that the medical profession followed the proper protocol in prescribing her medications. It is common knowledge in the mental health community that it can take at least six weeks for psychotropic drugs to begin to fully stabilize the patient. That process was never followed for Jessica, as doctors changed her medication ten times over the course of her treatment. None of them had the opportunity to fully work, nor was that time frame protocol ever explained to her or her parents.
     One has to wonder what is in the mind of the people responsible for treating this young lady. While hospitalized, she once drew a picture of herself in her journal, holding a gun to her head and pulling the trigger. Surprisingly, the medical personal at that facility found nothing wrong with that expression and shortly thereafter, discharged her from care. Young people commonly use art to express their emotions, and this was at the very least, a troubling indicator. Obviously, she had morbid thoughts while in the care of professionals, but no one acted on that clear warning sign. It is disconcerting that they not consider this self-portrait disturbing in any way.
     It must be added that on one occasion, Lauelwood would not admit her because of a positive drug test. Once again, many facilities do look for reasons to not accept people in crisis, and self-medication is one. The other is to argue that the basis for the maladaptive symptoms is behavioral in nature, not mental. This ignores that the common symptoms of mental illness is the behavior itself. An added roadblock is it will rarely be a psychiatrist that will make that judgment to discharge, as few hospitals have one on staff in the emergency room.
     There were so many other opportunities that the professionals missed. While she was on this downward spiral from her illness, she lost the ability to excel in school and had to be home schooled. As a time Magazine article titled,   “Manic Depression; Young and Bipolar” pointed out; Bipolar’s find school difficult because of the background noise of the disorder …” Her inability to function should have been a deadly warning sign to the medical providers who did not heed the symptoms of impending problems.
     There is something that must be pointed out, and that is Jessica was not your typical teenager suffering in denial. She was a unique young woman, who broke many myths of mental illness.  She never denied that she was sick, and she fought this disease in a way few people would have the courage to battle. She had a job, she did modeling, and she loved animals and possessed a passion for life that was hindered by a disease.  
     Though she broke one myth by accepting her affliction, it was the effort to find a treatment that was the main source of her downfall. . Much has been made of some past drug use, and that is a common characteristic known as self-medication. Like many others that belong to the same fraternity of “bipolar’s”, I used an alternative remedy. My treatment consisted of sitting alone in a room, drink straight Gin and take numerous Benadryl tablets. It accomplished my goal to calm my rapid thoughts and numb the emotional pain. Jessica Fernandez, though she described herself as one, was no addict. She was just a teenager trying to find something to make herself feel normal. The public does not understand that self-medication is idiosyncratic of mental illness!
     Another myth that was dispelled is that mental illness is usually prevalent only in dysfunctional families. Jessica’s parents are two particularly good hardworking people, and it is so evident of how much they loved her. They stood beside her every step of her journey, and never once gave up on her. They arranged their work schedules to be with her in case she needed them. The two of them spent countless hours in hospitals, and doctor’s offices desperately trying to save her. They did not fail Jessica, but they did discover that all the unconditional love in the world does not cure a physical malady.
     Dr. Kay Redfield Jamison, an award winning author, the head of psychiatry at John Hopkins hospital in Washington DC and a lifetime sufferer of bipolar disorder once said: People don’t realize how much suicidal people hurt, how long they hurt, and how hopelessly they hurt!”  Jessica was a girl in unbearable pain, and like countless others, found herself trapped in the confines of a deadly and misunderstood disease.
     Strangely, there were few conflicting indicators leading up to the fateful day. On the wall of her bedroom, she had a list of what she treasured most. It said; “Mom and Dad, Wisdom, Kyle, Honesty, Pets, Life, Dance and sobriety.” She also had several future dates marked on her calendar, such as her birthday and other future activates.  She did have future plans,  and she gave every indication that she was determined to get better.
     When her father was asked, what the most frustrating part of their seeking help was for Jessica, he did not hesitate “I could not get her the long term help she needed, which was at least a thirty day stay in a facility.” This is a common challenge for parents and loved ones. The facilities for long term care for Jessica are decidedly limited in number. There is little doubt that she did in fact need that long term care in a facility that would have monitored her medication closely, and allowed it the time needed to stabilize her. If that would have occurred, along with acceptance of her chronic illness, there was a strong likelihood of her recovery.
     There is one message that must be conveyed to the medical providers who insisted that Jessica’s issues were not mental, but drug related. In her autopsy report, there were no illicit drugs in her system. All that her toxicology report showed  was the medication that these professionals prescribed.  Yet, the medication that in the past, was never given a chance to work!
     If I were to write an epilogue to this story, two issues stand out. First, the intense and tireless desire of her parents who never gave up in their attempts to find the proper help for their daughter. They are two loving, and now grieving people who are now committed to helping others avoid a similar fate. They did everything humanely possible to help Jessica defeat this relentless disease.
     The second issue is to ask a simple question. When will the leaders of this State decide to finally make some positive enhancements to the mental health system? First, begin the process of making readily available treatment available to everyone. Next, it is time to MANDATE the treat them and street them mentality of the medical profession end immediately! If people think that this system is working, I know two people in Vermilion who bear witness to the pain that this barbaric system can create! Hopefully, someone in Columbus is listening!

20 comments:

  1. thank you for this. she was a long time friend of mine and I was rooting for her all throughout the years. I hope she is finally at peace now.

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  2. love you jess miss you !

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  3. I as a parent of a bipolar child i absolutely agree the amount of help needed and not recieved is below inadequet the entire process of incorrect meds or that the med levels are off or the dosage is wrong seems to be a standard that should not exist for the parents or individuals dealing with this is i truly hope someone somewhere will get off there a** and do something to help chaange the standard of care

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  4. I also a parent of a bipolar, have gone through years of no help from the mental health community, the treatment in this area is limited and I believe that the doctors only treat by prescribing medicine after medicine never listening to us on what is happening, their answer is try this pill, to only make it worse when they need help there is no where to send them cause the beds are full. Someone needs to do something to change this.

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  5. RIP Jessica...I know Lil Andrea was there for you!!!!!!

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  7. I have been through the ringer that they call mental health treatment in Lorain County. The medications I was prescribed, despite informing them I had issues with certain types of medications in the past, has destroyed my life because of the side effects. They affected my judgement worse than any street drug ever did, matter of fact it took away any sense of good judgement what so ever. I did things on those medications I never would have with out, and ended up with a criminal record. The courts in Lorain county do not care that you had a bad reaction to legally prescribed medication, they just want a conviction so they can thump their chests and pat their selves on the back. Now that I have a criminal record because of these so called medications, I cant get a decent job. The system is broken, and I will never seek help from any one in Lorain County again. I am much better off with out them!!!!

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  8. It is definitely true that it is difficult to find long term inpatient psychiatric care, especially for adolescents. However, it would be more effective to try to lobby so that psychiatric care is covered by both private and medicare/medicaid insurers at more than the 3-5 days for stabilization. The change toward community mental health began during the Reagan era with deinstitutionalization, aimed at keeping mentally ill out of facilities with the thinking being it was more humane and better for the patients to be out in the community. Inpatient psych health care providers know that psychiatric patients would benefit from staying the length of time needed for medications to begin working. The problem is that NO insurance will pay for this. If the psychiatric units in the hospital kept people until such time it would bankrupt the hospital and the units would close, as soo many of them already have, hence the difficulty finding beds. All they can do is stabilize and release to community mental health agencies. If the goal is to improve the situation it would be more beneficial to change the legislation about mental health treatment as opposed to blaming the few hospitals who still offer this service. The state institution does keep the patients about a month but the state will cover this service for that type of institution, not community hospital based inpatient psychiatric care. It is a great thing you are doing raising awareness but simply critizing the few facilities still open will not fix the problem, advocacy focused on changing legislation will.

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    1. Thank you for your comment, but I just wanted to clarify a few things. I and many many others have been lobbying the state government for additional funding and for changes in the law. We are constantly being told that the funding does not exist. Many of us have worked tirelessly for the needed change. However, people in Columbus are deaf to the real issues facing people in need.

      Deinstitutionalization during the Kennedy administration with the goal to have consumers having local "clinics" to be available for those in need to seek treatment, rather then Mental hospitals. The promised money for these community centers NEVER materialized. Reagan gets the blame, but it began long before him.

      Again, thank you for your comment.

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  9. My brother is bi-polar. My family has been to hell and back with him so many times. Jessica's family is right on target with every thing the have revealed for this article. One time a few years back my brother was in one of the mentioned hospitals. He went in in bad shape and went down hill everyday. He ended up on suicide watch in the hospital. My mom was there everyday because SHE as a parent knew something was not right. After she threw a fit one day they brought her his file and guess what for 10 DAYS these so-called professionals were giving my brother SOMEONE ELSE'S MEDICATION. One mental health facility in Lorain had him on 10 different medication at the same time. A pill for this a pill for that and just one for good measure. Come back and see me next month. Today he only takes 2. My brother does not like living with this disease. So many times I have heard I wonder why I am sick and you are not and it just breaks my heart in half.

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  10. I feel as though this article is playing the same old game, blame the hospital(s)/healthcare professionals! As a healthcare worker, I can assure you most indviduals (can't say all) go above and beyond for these patients. There is no thanks or gratitude for all those that do receive benefit and have positive outcomes. It's very difficult to continue to help people when these are the only words spoken.

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    1. I am not a healthcare professional (although my wife is) but I was thinking the same thing... How many patients currently living in the community are leading full, productive lives thanks to the Doctors, Nurses and Hospitals that are helping them? We'll never no because the success stories are never printed... they're not 'News Worthy'! And another statement/question... where was Jessica's Primary Care Physician during all this?!?! I would think as a parent or patient, you would want at least ONE Healthcare Professional overseeing, and keeping records of what was going on!!! Someone who could 'intervene' on her behalf and help direct her and her parents to the proper care she needed. There is another problem however, that cannot be overlooked in this tragedy... that has to do with all of those people in society who claim to have a 'mental disorder' but don't, only to be diagnosed as 'unable' to work and collect free medical and SSI the rest of their life... sad but true...

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    2. I am glad you wrote and thank you.

      First off, her parents took her from Doctor to doctor trying to get her help, and primary care physicians are NOT qualified to deal with mental health issues. In hospital ER's very few will have a psychiatrist on staff, which means they are treated and released.

      I agree there are many living good lives, as I am one of them. But to say they are not newsworthy just shows how out of touch you are with reality. Ask most police departments who are the ones that deal directly with this issue and ask them if the medical community is doing their job with people in mental health crisis. They will give you the same answers I am, because they see the failures on a daily basis.

      I find it ironic that you single out people with mental health conditions trying to collect free medical and SSI for the rest of their lives. Why did you single them out? Why not the people who claim back injuries? Their are a hell of a lot more of them who collect then those with mental health issues!

      Finally, in regards to that statement about faking disability. I have a job, a business, and am an award winning author. I have done training programs for law enforcement, medical professionals, and work with high schools on suicide prevention programs. I think that qualifies me as someone who understands the system.Oh, and my wife is an RN, and agree with the article.

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  11. First off, thank you for your comment.

    Secondly, I am not blaming the "healthcare worker". My wife is an RN, and she has a background in mental health. I never attacked the actual people in the trenches who do go above and beyond.

    Finally, I have been using that story about Jessica in different training programs and people sit there in almost total agreement that this was a major failure. Especially the first responders, the police, as they deal with situations like Jessica on a daily basis. So often they bring an individual in crisis in the front door of a local ER, only to find out they are discharged without significant treatment.

    These cases are not an anomaly, they occur every day! Show me positives that outnumber these negative ones, and I will write about them. As of now, the only group that I can write about in a positive fashion is the local police. In fact I have a positive story coming up in the near future on one local department.

    Again thank you.

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  12. My question for you, why do positives have to outnumber the negatives to be worthy of praise and newsworthy? From your introduction section on your blog, you claim to have had a positive outcome...

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    1. If you would have read my blog you would have stumbled on a positive story on Gathering hope house in Lorain. It is a terrific facility that has saved lives.

      I wish I had more positives to write about, but that is not the current state of the Mental Health system. I wrote a column about Mercy Hospital, and they never even responded to my questions.

      When I see fewer people going through the "treat and street" mentality of most hospitals, then there will be some positive outcomes.

      My positive outcome was not easy and it was 11 years ago. However, I do face the stigma of this disease from members of the medical community right in Lorain County.Some of those leaders consider mentally ill people to be part of a subculture and barely human. Yes, these are leaders in the medical community, and I recovered in spite of that behavior.

      Thank you once again

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  13. What a great article. If only it was required reading. I, too, am bi-polar, and finding and keeping employment has been a lifelong struggle. In light of that,I have been one of the fortunate ones where friends and loved ones I have surrounded myself with have given me chances while major employers have not. Which brings us to public assistance. Many, many bi-polar sufferers simply are not capable of holding down decent employment and must turn to the chastised system of some type of public subsidizing, only to be shunned by friends, family, and of course the conservative thinkers of America that lump everyone into the "loser" category and wish to write them off as lazy and useless. The only way to get it through the thick skulls of some of these people that bi-polar disorder is an illness,not a desire, is for them to experience it first hand through themselves or a loved one, something I wouldn't wish on an enemy.

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  14. I am Bi-Polar and for the most part live a productive life. I just want to thank you and Jessica's parents for sharing this story because there are so many young people suffering with this illness and feel alone. God bless Jessica's parents,I hope that something good will come out of this. I agree that there should be more focus with mental health and I hope that there will be changes soon.

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  15. Thank you for this blog.. My heart goes out to Jessica's parents.

    In 2010 I became a parent of a "cutter" all they would do is keep him for 5 to 7 days, have family meetings more meds and let him out with NO help for me to offer him. Finally after doing this every other week for 2 months I was told if I was on welfare or if he had a probation officer they could help me more. (YOU have got to be kidding me..!! I am a single mom, I work and have medical coverage through my employer) But for my son to get the help he needs I would be better off giving him up to the county for longer care treatment.
    With lots of prayers and help from Oakview Point at Southwest he has been on the right track!!
    But he always thought he was bipolar.
    So now reading this story of Jessica and her fight and feelings sounds so much of my son.. this is going to push me to look even deeper for him.

    Thank you again

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  16. I found this page while searching for material that might relate to my own site.

    http://privatemail.fastmail.fm

    My story was very different but caused in some instances by the same problems.

    I had what I call book keeper deficiency syndrome.

    It was compounded by malicious slander syndrome which utterly wrecked my life.

    For me suicide is probably the only way to avoid medical treatment for "delusions of illtreatment by doctors".

    Also to avoid a damned good kicking from local law enforcement as local mental health were allowed to rope in all manner of people into a campaign of persecution long after I had notified all the relevant authorities and provided them with ample evidence of something having gone very very wrong in my case.

    The lesson to learn from my case is that juries must be present at tribunals. What is happening behind closed doors at the moment is outrageous and will not change while the public don't put their foot down.

    People won't do what they don't want to do unless you force them.

    John Morley
    January 2013

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