TO: JOHN RYAN, Mental Health Director
FROM: THERESA GALVEZ, Chief Patients’ Rights Advocate
DATE: April 18, 1998
SUBJECT: STRINGER HEARING
After reading a copy of Dr. Dorsey’s recapitulation of Kathi Stringer’s hearing held on April 16, 1998, I would like to respond to several areas:
- It is my understanding that the Public Defender and the Patients’ Rights Offices believe that there was no "good cause" for placing Ms. Stringer in seclusion on 4/14/98 at 1410, for the defiant act of removing the tape from the floor, This conclusion is based on:
A. The telephone order was written; "Place pt in seclusion for danger to self as marker dx tearing up tape off floor and crossing into off limits area. NTE 4 hours".
B. The progress notes do not reflect: 1) What made this act dangerous to Ms. Stringer. She was not threatening to harm her self, she did not exhibit self injurious behavior, and she was not threatening harm to others, and she did not attempt to exit Unit A; 2) There is no documentation in the progress notes of attempts to re-direct her behind the area which had been marked, no documentation that she refused to cooperate in the redirection; 3) There is no documentation that least restrictive measures were attempted by staff and refused by Ms. Stringer.
The difference is in the interpretation and the fact that the documentation does not meet Title 9 requirements for: a) injury to Ms. Stringer; or b) the infringement on the rights of others; or c) the suffering of serious damage to the facility; and equally important, is that seclusion was the most restrictive measure based on no documentation for less restrictive measures and based oil the only documentation of her action of solely removing the masking tape from the floor.
California Administrative Code Title 9, Section 865.2, Good Cause for Denial of Rights requires the above This information was provided to all parties receiving a copy of this E-Mail on April 14, 1998, "Information on Denial of Rights - Stringer Case.
In addition to the use of seclusion, at 1400 an order was typed: "May have one change of clothes in her room, plus one more in locker on nursing unit". Good cause is not reflected in this order nor is it contained in the progress notes. Nursing staff carried out this order without legal cause and seized not only Ms. Stringer’s clothing but included her books. The denial of Ms. Stringer’s right to her clothing and books was not related to her exercising these rights.
These additional actions were opined to be in violation of the Regulations, in addition to appearing punitive and non-therapeutic. Please recall that the Court had affirmed on 4/10/98 that certain property items were removed without good cause.
It is my opinion that California Welfare & Institutions Code rights under 5325 could be denied with the proper documentation, on inferred danger and that "reasonably foreseen" can be utilized via documented less restrictive ways of protecting danger to self or, others, and serious damage by the facility, by the persons’ refusal to cooperate with re—direction, failure to contract, and/or current verbal or physical threats and not based solely on past incidents.
In the facility’s attempt to set firm limits with Ms. Stringer to prevent any injury from again climbing on to the patio cover, the masking tape was placed in a position on the floor which denies her free access to: 1~water drinking fountain; 2}the two phones utilized to place and receive telephone calls; 3)the bathroom and shower. This restriction infringes upon her W&I Code 5325 rights and State and Federal constitutional rights affirmed in W&I Code 5325.1. Ms. Stringer is therefore required to ask for permission to exercise these basic! rights which may be delayed based on the availability of staff.
- It is my understanding that there were three separate matters which were scheduled to be heard in this case, none which were a writ.
The first and only matter which was heard, and not concluded, was the petition for denial of rights and restoration. The second petition on calendar was for placement. The third matter was the Riese petition1 The latter two petitions were not heard, however testimony was presented and heard which pertained to placement and Riese. Ms. Stringer had withdrawn the writ and retains her right to a writ on her temporary conservatorship status. No writ was denied.
- My interpretation is that the petition on the denial of rights and restoration, the petition for placement, and the Riese hearings have all been continued to Tuesday, April 21, 1998, at 1:15 p.m.
- My understanding of the motion granted by Judge Sullivan to Cheryl Thompson in approving an independent psychiatric review was for the following reasons: diagnosis; evaluation of whether or not Kathi Stringer is psychotic; her dangerousness to self or others; benefits, if any, of psychotherapy during hospitalization; and, whether or not Kathi Stringer has received appropriate and therapeutic psychiatric treatment.
- My interpretation is that Judge Sullivan did not make a decision about Kathi Stringer’s baby bottle, which is her property, pending the independent psychiatric second opinion. It is also my opinion that had Judge Sullivan rendered a. decision it appeared that he was leaning towards a decision against Ms. Stringer not having the baby bottle returned. Also, no ruling was made on the seclusion and clothing denial of rights issues.
Patients’ Rights will be filing a complaint and referral to Licensing and the State Office of Patients’ Rights on the above non-compliance areas identified and disputed, regardless of the Court’s decision in the areas. This action is being taken to ensure and to affirm that the Title 9 regulations on the denial of rights for every person in Riverside County who will be admitted to any licensed health facility are upheld and enforced and that treatment modalities will not be used to deny any W&I Code 5325 rights or 5325.1 rights.
cc: Dr. Dorsey
Larry Ogilvie
Deborah Johnson
Jan Gardner