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!