Mental Illness and the Right to Die
January 12, 2001
IN THE CIRCUIT COURT OF
THE STATE OF OREGON
IN AND FOR THE COUNTY OF CLACKAMAS
In the matter of Kathi Stringer,
Alleged Mentally Ill Person.
| STATE OF OREGON,
Petitioner, vs. KATHI STRINGER Respondent. |
) ) ) ) ) Case No. M-0101-22 ) ) ) ) |
JANUARY 12, 2001
TRANSCRIPT OF PROCEEDINGS
BE IT REMEMBERED That the above-entitled matter came on regularly for Civil Commitment Hearing before the Honorable Art Knauss, Pro Tem Judge of Circuit Court of the County of Clackamas, State of Oregon, commencing at the hour of 10:00 a.m., on Friday, the 12th day of January, 2001, at Portland, Adventist Medical Center, 10123 SE Market Street, Portland, Oregon, 97216.
APPEARANCES
Appearing in the behalf of Petitioner:
Clackamas County District Attorneys Office
807 Main Street, Room 7
Oregon City, Oregon 97045
Appearing in the behalf of Respondent:
Clancy & Slininger
181 N. Grant Street, Suite 203
Canby, Oregon 97013
ALSO PRESENT
Dr. Jerry McCubbin
Court Appointed Psychologist
Mr. Sand Carlyle
Court Appointed Certified Mental Health Examiner
I N D E X
WITNESS
SARAH LINDEN
Direct Examination by Mr. Jette:.......................2
Cross-examination by Mr. Clancy:....................5
Examination by Mr. Carlyle................................9
Examination by Dr. McCubbin:..........................9
Examination by The Court:................................10
EXAMINATION OF KATHI STRINGER
Examination by Mr. Carlyle:..............................12
Examination by Dr. McCubbin:.........................16
Examination by The Court.................................17
E X H
I B I T S
EXHIBIT DESCRIPTION ORDERED RECEIVED
No. 1 Precommitment Investigator's Report Page 5 Page 5
P R O C E E D I N G S
(Whereupon, the hearing
convened at 10:00 a.m.)
THE COURT: All right. You're Kathi Stringer?
MS. STRINGER: Yes.
THE COURT: I'm the judge in these proceedings, and these are the doctors that'll be examining you in a little while. This is a hearing to determine whether or not you suffer frm a mental disorder or illness, and if you do, if you're dangerous to yourself or to others or are unable to care for you basic needs. If I find that, you could be committed to the hospital for up to six months.
You had a right to an attorney. Mr. Clancy's been appointed to represent you. You have a right to have any witnesses here to testify in your own behalf and to subpoena them, if need be. Do you understand your rights?
MS. STRINGER: Yes, I do.
THE COURT: All right. Okay, go ahead Mr. Jette, call your first witness.
MR. JETTE: Your Honor, our first witness is Sarah Linden.
SARAH LINDEN
was thereupon called as a witness in behalf of the respondent, and after having been first duly sworn, was examined and testified as follows:
THE COURT: State your full name, please.
THE WITNESS: Sarah Linden.
DIRECT EXAMINATION
By MR. JETTE:
Q. Hi, Ms Linden. If you could just tell the Court your position at Clackamas County.
A. I'm a mental health investigator for Clackamas County Mental Health.
Q. Have you done an investigation on Ms. Kathi Stringer?
A. Yes, I have.
Q. And can you tell us the day and how long that visit was?
A. I met with her twice during this last hold period. I met with her on the 9th and then, again, on the 11th. So, I believe each meeting was about 20 or 30 minutes.
Q. On the meeting on the 9th, can you just give us a brief narrative of the interaction you had with Ms. Stringer?
A. She told me she wanted to die. She said she was angry that she hadn't been allowed to die -- allowed to suicide. She said several times, "I'm untreatable." I could see her forearms and most of the areas of her forearms were reddened, couple of scratches and abrasions, and she had a bandaged wrist. She spoke a great deal about her mistreatment at another facility. She really wasn't able to
say what she thought would be helpful.
Q. Did she indicate how she got the abrasions or the scratches on her forearms?
A. You know, I didn't directly question her about that. I said, "I see what you've done to your forearms, and she said, "Yes." And I didn't really question her any further.
Q. You mentioned that she -- did she attempt to try to kill herself?
A. She has cut her wrists prior to coming to this hospital. She told me what she was going to do when she left the hospital is drink Bailey's Irish Cream and cover it with some milk.
Q. Now, you indicated she indicated to you about some mistreatment and so on?
A. Yes.
Q. Can you briefly give us a narrative of what she conveyed to you of the mistreatment?
A. She felt the staff was disrespectful to her.
Q. Do you know if Ms. Stringer ever talked to you about any delusions?
A. No. I did not see any evidence of psychosis.
Q. In your report, you say you met with her yesterday.
Can you briefly give a scenario on your meeting yesterday with Ms. Stringer?
A. She looked calmer. You know, she questioned the diagnosis that I had tentatively put in the commitment report and stated she has been through psych testing and that she has PTSD and borderline depressive disorder, and we just talked about the hearing, basically. I did not discuss her suicidality with her.
Q. Do you know if Ms. Stringer is currently on medication?
A. She is on medications at the hospital and she's cooperative in talking them.
Q. Do you know if she had the ability if she were to leave the hospital, do you know if she has the ability to take care of her basic needs, her employment, or housing?
A. She has an income and she does have an apartment.
Q. And those resources with be there?
A. I really didn't ask her about it.
Q. In your opinion, does Ms. Stringer pose a danger to herself?
A. I think that she does right now. I did ask her if she thought that her judgment was good right now, and she was open to it, and she said, yeah, she felt her judgment was good because she felt she didn't have other choices accept for suicide, and that I don't know her really well to say
right now.
Q. And in your report, you remarked that she was unable to provide for her basic needs or -- no. I'm reading this wrong. I'm reading that wrong. Double negative. I'm sorry.
MR. JETTE: Your Honor, I would like to submit pages 3 and 4 of the report into the record.
(Exhibit No.1 offered into evidence.)
THE COURT: Any objection?
MR. CLANCY: No, Your Honor.
THE COURT: Be received.
(Exhibit No. 1 received into evidence.)
THE COURT: Mr. Clancy?
MR. CLANCY: Just a few questions.
CROSS -EXAMINATION
BY MR. CLANCY:
Q. Did you ask her in terms of whether or not she is willing to participate in voluntary treatment outside of the hospital setting?
A. I didn't ask her.
Q Is that important to know whether or not she would do that?
A. My guess is that she would, I think. The question of her safety is the most important one right now, in my
opinion.
Q. Do you know if she had been seeing someone or had been on medication prior to the time that you saw her?
A. I believe that she has, recently, in the last few months, moved from California to Oregon, and I'm not sure if she has met -- or if she has been able to get services thought Kaiser here yet. Sometimes it's a bit of a wait.
Q. But she does have ongoing Kaiser coverage and has been treated by Kaiser?
A. This is correct.
Q. If she were to stay on medication and to get plugged in with a therapist at Kaiser, does she have the means to be able to exist on her own, do you think, outside of the hospital? She does have an income and a place to which to live?
A. (Witness nodded head.)
Q. And the last time you saw her, she was not having the same conversations in terms of actively suicidal at that time?
A. I didn't discuss -- I didn't question her directly about her suicidality. I talked primarily about the hearing and the commitment report, the P.C.I, the precommitment report you all got.
Q Did she give you any details in terms of her treatment down in California and the reasons she was upset?
Besides the staff was disrespectful, did she give you any particulars in terms of what happened?
A. She did tell me she felt that all of the shifts had made very derogatory statements about her and -- I think you need to ask her in more detail about that.
Q. Did she tell you she, in fact, filed a lawsuit against the hospital down in California?
A. Yes, she did.
Q. And did she discuss with you her background and, min particular, history of her having been abused, herself?
A. I asked her briefly about it. I did not go into length about it. I didn't -- I felt that it dad some bearing upon the current situation, but my primary focus was whether she was going to attempt suicide again or not, or do other self-harm kinds of actions.
Q. And based on your knowledge of her history that she gave you, it it possible she is in fact, suffering from a Posttraumatic Stress Syndrome?
A. Certainly.
Q. So, when you discussed that with her, and in your diagnose, even though you didn't list that, you think that that is possible that that is part of what's driving her problems?
A. Yes. She does have a psych testing that shows that.
Q. Was any prior report from her other hospitalizations
in California available to you?
A. No.
Q. At this point, what would she have to do, in your opinion, what would she have to do to convince people she was not actively suicidal and able to take care of herself?
A. I felt this was a very difficult one to bring to commitment hearing because my preference would be she has control over her own actions and able to guarantee her own safety. However, there have been so much self-harm done in the hospital and too many statements made to myself and hospital staff that she intends to suicide when she leaves the hospital, that I'm asking the court to make a decision about what happens.
Q. So, then, part of the reason for your recommendation is the fact that there have been some reports of and attempts of self-harming since she's been in the hospital?
A. Correct.
Q. Would she be an appropriate candidate for some kind of a conditional release upon her having some therapy and voluntary treatment on the outside?
A. I'm not sure her friends is willing to take on that responsibility.
Q. So, she might be willing to participate, but you're not too sure they're willing to supervise that?
A. Correct.
Q. If they were and she was committed to doing that, you think she could be successful in doing that?
A. I don't know.
Q. Any other things that cause you concern about her, other then the suicidal threats and actions at this point?
A. No.
Q. All right. Thank you. That's all question I have.
THE COURT: Questions?
EXAMINATION
BY MR. CARLYLE:
Q. Well, it sounds like she's pretty hopeless that there is anything that can help.
A. Correct.
Q. And she hasn't been willing to contract her safety?
A. No.
MR. CARLYLE: All right. I don't have any other questions.
EXAMINATION
BY DR. MCCUBIN:
Q. Oh, I'm not clear on her support system. She has friends here in the area? Do you have them here right now?
A. Yes.
Q. Okay. And has she lived in Oregon before or Oregon her home or she move back to Oregon for the first time or --
A. When I asked her about it, I didn't get a great
detail. Of my understanding, she moved back here because she had some friends here, and she had -- all this is hearsay.
Q. Family is somewhere else?
A. Yeah.
Q. And not in Oregon?
A. No.
DR. MCCUBBIN: Okay. I don't have other questions at this time.
EXAMINATION
BY THE COURT:
Q. Is she -- is there an issue of leaving or felling here?
A. No.
Q. She looks thin, is she eating?
A. I don't think she's in danger here right now. She's certainly restricting her intake while she was in the hospital and told me she's lost weight.
Q. Does she tell you why she's not eating?
A. No.
Q. Her voice was quite hoarse when I talked to her.
A. She thought she -- the nurse said it was probably she hasn't been drinking very much.
Q. While she was in the hospital, here, do you know --
A. I'm sorry.
Q. Do you know what efforts she's made to do herself in
while in the hospital?
A. Well, you've seen her forearms, and, according to the physical records, she's taken plastic utensils and scratched herself with them, took her fingernails and scratched herself, and took a wire out of an artificial plant.
Q. And did what with it?
A. I don't think she did, actually, do anything with it. I think the staff found it before she did anything.
Q. Okay. And is she on medication now?
A. Yes.
Q. Okay. Thank you.
THE COURT: Next witness.
MR. JETTE: Your Honor, State has no more witnesses.
THE COURT: Mr. Clancy?
MR. JETTE: Your Honor, I have no more witnesses to call at this point.
THE COURT: And do you want to make a statement?
MR. CLANCY: I've advised her of the fact she can either make a statement or not and she has indicated to me she doesn't want to make a statement this morning.
THE COURT: All right. Any questions?
MR. CARLYLE: Sure
EXAMINATION OF KATHI STRINGER
EXAMINATION
BY MR. CARLYLE:
Q. Kathi, my name is Sam Carlyle.
A. Yes.
Q. Well, you're taking some medication, antidepressive medication, and, also, something to stabilize your thinking and your mood.
A. That's what I've been told.
Q. Why are you talking the medicine?
A. In an attempt to stabilize me, is what I've been told.
Q. So, are you hopeful that that'll help with your depression?
A. I'm not hopeful of anything.
Q. Okay, I'm curious, how do you know when people are being respectful? How do you experience that?
A. Well, when you hear a doctor in court tell a Superior Court judge that treatment staff doesn't grant care to a 45 year old, regressive adult because they're repulsed by her, I get the idea. When I hear staff tell me in earshot, "What's wrong with her?" And another staff says, "She's koo-koo." And another staff says what's wrong with her in another unit and, "Well, she's just crazy." Well --
This particular hospital has made me an offer to settle and the Grand Jury made some significant findings with the hospital that management has been mistreating staff. I have two other witnesses that says I have Posttraumatic Syndrome. Doctors and people -- one of my witnesses is a person that left because they asked him to do some things he felt were unethical. Their expert, their witness, was the person that discovered that when I was under extreme distress it could be seen that I could exhibit some of those personality traits. I had pretty much used up all my options. I feel like I'm a burden on the community. I feel I'm a burden on my family. I feel like I'm a burden on my friends. I just haven't seen anything that works.
And as far as people being respectful to me, I've got 3000 pages of multidisciplinary notes. Like this (indication). Most people couldn't read it. They couldn't get through it, it's that awful.
Q. You've had 23 psychiatric hospitalizations?
A. I think the other day I had them laid out on the floor. I think counting this one, the next one would be, like 31.
Q. Can you tell me a little bit about what symptoms of posttraumatic stress that you have?
A. Well, the symptoms that I have right now: I wake up at night screaming; when people come up behind me, I jump; I sit around and I can't remember a whole lot of things
that's going on in my day to day activities because my mind is thinking about what happened to me in the hospital. I play it over and over again. I get sucked into it. Next thing, I got self-abuse, and I don't even want to talk about the pain.
Q. So, it's painful? Many of the symptoms stem from the hospital you were in?
A. Right
Q. But the symptoms predate that?
A. Right. I went through a very traumatic childhood, and, after that, I took all my anger and I put it into positive drive and succeeded. When I was 23 I just worked for myself, and I established a company and by the time I was 26, I was a key supplier for Hughes Aircraft and some other major companies. Then I had my breakdown, and I was never able to recover. But my posttraumatic stress came from when I was in this hospital, and I seen all these things that they were saying. It was just horrendous. And, yeah, it brought back from my childhood that I decided to leave behind and make something more positive from myself.
But now I have -- I mean, we're talking three shifts of people and a whole staff of people, maybe three or four that might be okay.
I have a relative who works as a charge nurse, and I heard what the people said in the ward when I would go back
to when I was two and a half year old because I've had this regression thing going on because I had problems stemming in childhood. I had poor ego-strength and I just needed a rest to get it back together. Instead they tore me apart.
Q. The baby bottle, is that something that's soothing when you regress?
A. Yes. It's a transitional object. I don't use it very much. It was given to me by my niece. I feel my child alter has been killed off. It's not been integrated. I feel like she's been killed off. There was major transference problems in the hospital, and they never did see what happens, and I [crying] - - - - - they tell you something, you just melt into a place and, yeah, now, I believe it. I'm thinking, maybe, I'm worthless. Yeah. I believe what there're telling me.
Q. I can tell by some of the language that you use, you've done some self-study. Or is it wording that you're used to? It that from your experiences from therapy?
A. No. I read a lot of books from Erickson (phonetic) and others.
Q. So, you're trying to investigate this?
A. Well, when I hurt so badly. I'm trying to find out when did they do this to me. First thing I did, I went to the college and I read all those books, and I got interested. I thought, they're not treating me very nice. At least, that's what I thought, so, I read these books from the APA's and I have an award
winning site on the internet. I read a lot of articles. I did a lot of find out what was intellectually going on. My IQ isn't that poor. I didn't have that problem.
My whole problem is posttraumatic stress from these people saying I'm repulsive. I got one doctor that came in, and they asked him, "Why won't you let Kathi have a baby bottle?" And he said, "I'm afraid she might put urine and feces in it and drink it." Why would they say that? I'm a successful person and business person. I just needed a rest. Why can't I have a rest? I'm not involved with this culture anymore. I'm on the wrong planet. I just want out. [crying]
MR. CARLYLE: I don't have other questions.
DR. MCCUBBIN: I'd like to ask a couple of questions. Do you need a little rest here?
THE WITNESS: [crying] I'm pulling it together. Go ahead.
EXAMINATION
BY DR. MCCUBBIN:
Q. I don't question your statements, exactly, but I'm wondering what you think we should do if we were going to be fair to you today.
A. I don't think - - personally, I don't think there is any available treatment. I think I'm untreatable. There is got to be a point where you look at the construct of the characteristical dimensions and how you score each one, and you've got to look at it and say, well she's just not
treatable.
Q. I think I just wrote it. I said it was a resistance to effective treatment, and that might make you untreatable.
A. How do you know what's effective treatment?
Q. Because it doesn't work.
A. Well, it's not my resistance. I'm not resistant to anything that I think will work.
Q. Well, I don't think it's a hundred percent on the side of the treatment people. I think there has to be - - it's very difficult if there is no hope inside of you, and that's what I see. And that makes me sad, and I think - - I think - - I would vote to keep you in the hospital because I don't think you're safe. And I've never been in that chair, but that's what I would want you to do to me if I wasn't safe. I don't have other questions.
EXAMINATION
BY THE COURT:
Q. Well, you want me to let you go so you can go an kill yourself, is that what you're saying?
A. Well, I think you fist have to determine philosophically what is good judgment. Is good judgment to want to live? Is that where the premium responsibility lies for the right to live or the right to die? If I've tried everything available to me, and I can't get through it, and I haven't seen any new
information that gives me hope, then, in my good judgment, based on my insight, which I think is pretty good from all my studies, I should be able to make the decision I want to die.
MR. CARLYLE: From your research, have you come across something called, Dialectical Behavior?
MS. STRINGER: Marsha. I've read her. I've read her book. In fact, I've got a mental health medical book site, and I sell her book. No. It doesn't work.
MR. CARLYLE: If you'll put all the diagnostic stuff aside for a moment because I really see what could be a lapse, and such. But if you look at the behavior and the symptoms - - you have the kind of self-mutilative behavior, sort of the hopeless mind-set that you have - I think that that treatment has been shown to decrease self-mutilative behavior and increase insight of the psychiatric treatment.
MS. STRINGER: Okay, that's where we have the problems. This is what I'm trying - - tried. The treatment staff won't do it because it's usually for a borderline - - [crying] okay, I'm sorry. I think just so you can better understand, if I can explain a couple more minutes, and then you'll have a better understanding.
MR. CARLYLE: Well, why don't you go over it. My sense is that you're way over intellectualizing all this. You're thinking too much about your thinking, and that's a therapy interfering behavior. Okay. That's all I need
to say.
MS. STRINGER: I understand. I've heard that before, and I've given that a lot of - - you know.
MR. CARLYLE: Because I think people what to help.
MS. STRINGER: I know they do. I know they do.
MR. CARLYLE: So, there is some barriers you need to cross there, and I don't know quite how you're going to do that.
MS. STRINGER: Let me just put it this way, this is about the best analogy I can think of. Do you have any children?
MR. CARLYLE: Yes.
MS. STRINGER: Let's say I have inside me, a child alter and that's got me [crying] - - I can't remember ever being held or rocked or loved as a child, never. So, I developed in my mind, like, this little person, two and a half years old. And every night before I went to bed, I would hug her, love her, hold her, take care of her. It was me but it was like a picture of me at a very young age. Every night, when I went to bed I did that. That was my thing. And in the morning I would get up and I would go for the things I wanted. I've been in national dance competitions, and I've won first place. I've done national dance. I've done a lot. I've done a lot of things in my life because of this person I
had loved so much, in my life.
And then when I regressed this one time, she came out for five days. They said, what are you going to do with her? Well, put her in the hospital maybe we can help her out. So, it was like, you know, it was like, they laughed at her [crying]. All she did was hold a bunny and a blanket and sit up again. They said she can't do anything.
So, I heard all those things - - and they try to manage you and took a child trying to - - [crying] trying, you know - - I can't - - you tear her away like that. They killed your child. I feel like she's gone. After they killed her, they tell you, you got to live with the mob. That's what I feel. I've got to live with the mob. So, that's - - [crying] so, all these cognitive things going on. And it's not one or two people. I'm talking about a whole culture, three shifts. This isn't my parents, my brothers or sisters. I've gotten away from that. I've proven I've gotten away from that.
MR. CARLYLE: Well, I think you're trying to understand all this, and that is the first step that leads to some acceptance of this, so you're ready to go on and start planning and continue to think about this to try to continue to understand what's happened to you and understand what motivates other people act the way they did. I agree if they did that, it's very unprofessional and very insensitive
for people to talk about that like that. Very. But that's all - - very - - but - - that's all.
BY THE COURT: (Continuing)
Q. When you were in this hospitalization, that was a particular hospital that was particularly bad?
A. It was about eight of them, and finally, I went to the public defenders office. They actually encouraged me. They actually wanted to get - - they wanted to get him the hell out of there, and they thought I could be the vehicle to do that.
Q. And what period of time was that?
A. It was 1986 to 1988. Oh wait, 19 - - I can't think. 1996 to 1998.
Q. Okay. What that in California?
A. Yes.
Q. How long have you been here in Oregon?
A. About six months
Q. Okay. And when were you last in the hospital?
A. In California? About a month ago. It was from Loma Linda before I came up here.
Q. Okay. Was that on a court commitment?
A. No. It was voluntary.
Q. Did you feel that there was some hope when you committed yourself?
A. Actually, I was in a car accident. I can't remember
how the car accident - - how I got into the accident. They thought maybe it could be from depression. I don't remember the accident ever happening.
Q. What are you going to do with the money?
A. What?
Q. What are you going to do with your money when you leave?
A. What money?
Q. You say you have a lawsuit pending?
A. It would all go to the attorneys. They work very hard. Right now it's in summary judgment. Do they have summary judgments up in Oregon?
Q. Okay. Yeah, well, they do. Are you hoping to get some money that might help you with your life?
A. No.
Q. Well, I'm sure judges have told you before, but I can't let you go to go kill yourself. I can't do that. I couldn't do that and I don't think any other judge would do that. Maybe that's cruel because people that are terminally ill, physically, want to die, and when you have cancer so bad where you don't want to live anymore. Oregon just passed a law that said that you can do that. We don't have a law that we can do that for people who have mental health issues. So, I'm not going to do it. I'm not going to let you do that.
(Whereby, the examiners completed their
reports and submitted them to the Court and counsel for review.)
THE COURT: Any argument on the part of the state?
MR. JETTE: No, Your Honor.
THE COURT: Mr. Clancy?
MR. CLANCY: No, Your Honor.
THE COURT: All right. I do find that Ms. Stringer does suffer from a mental illness or disorder and that she is definitely dangerous to herself. So, I'm going to order a commitment for up to six months. I'm also going to order that she be prohibited from purchasing firearms or possessing firearms. I don't know if that's an issue in the past, but that's my order.
(Hearing adjourned at 10:55 a.m.)