Some Details of the Grievances

Midway through his tenth year, Sean began to make credible suicide attempts. These included opening the car door and threatening to jump on the highway, holding kitchen knives to this throat and abdomen, climbing the roof and threatening to jump head-first, and hanging himself.

When Sean was ten years and eight months, the situation escalated to the extent that I could no longer guarantee his safety. I announced that I was gong to initiate hospitalization, which is something that Sean had dreaded. He astounded me by saying, "Good! Now I won’t have to kill myself." Upon receiving concurrence from his outpatient psychiatrist, Sean and I drove through 100 miles of dense fog and arrived at the hospital at 4:00 A.M.

Since he was a danger to himself, Sean was admitted under Section 5150 of the California Code that authorized mandatory three-day evaluations. As soon as this three-day period expired, the HMO cutoff all payments. Sean remained in the hospital four more days, but his level of service was reduced because of the HMO’s decision. For example, diagnostic tests that were ordered during the first three days were simply not done. Even more ominous was the fact that hospital records indicate that Sean was suicidal on each of the four days after the HMO cutoff payments - even on the eve of his discharge!

Sean was discharged despite his Mental Status Discharge Report indicating:

• Motor Activity: Restless
• Concentration: Brief
• Attention: Distractible
• Mood: Anxious
• Processes: Magical Thinking
• Impulse Control: Poor (This is particularly reprehensible in a child
  obsessed with suicidal thoughts, because he
  would lack to ability to control such impulses.)

Retrospectively, it became clear that Sean’s hopes for living were dashed by the HMO’s refusal to provide adequate hospitalization. Four months later, Sean wrapped one end of a strap around his neck and attached the other end to the side mirror of a pickup truck. He then knelt on the ground and hanged himself. My efforts at CPR failed, just as Sean was similarly failed by the cold, calculating treatment of his HMO.