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The Honolulu Advertiser

Posted on: Sunday, May 15, 2005

Mentally ill caught in system

 •  Better monitoring of patients sought

By Ken Kobayashi
Advertiser Courts Writer

In 1979, Lloyd Vasquez was caught driving a Chevrolet van without permission from the owner, a car rental company. He was charged with a felony, but was diagnosed with schizophrenia and acquitted by reason of insanity. Because he was considered dangerous, Vasquez was committed to Hawai'i State Hospital.

Lloyd Vasquez, a patient at Hawai'i State Hospital, has been in and out of the state's mental-health system since 1979. Vasquez's lawyers say he has been under the jurisdiction of the state longer than anyone they can recall for commission of a five-year felony.

Bruce Asato • The Honolulu Advertiser

Today, Vasquez, 49, remains at the Kane'ohe facility, 26 years after committing a crime that would have kept him in prison for a maximum of five years if he had not gotten an insanity acquittal.

"I feel like I'm a prisoner of the state of Hawai'i," Vasquez told The Advertiser recently.

Vasquez has not spent the entire 26 years at the facility. He has been released at various times, but he couldn't follow the conditions of his release, and state judges found he posed a danger and sent him back to the hospital.

Challenges for system

Vasquez's case demonstrates the challenges facing a system under a federal mandate to provide services to the seriously mentally ill in the community and to patients such as Vasquez should he be released.

The state is under pressure to come up with a plan to provide services ranging from residential treatment to individualized case management for the serious mentally ill. The latest estimate was that they number about 7,000.

The state's implementation of a "comprehensive" recovery system of adult mental-health services was due Jan. 23, but a federal judge gave the state until June 30, 2006.

Paul Guggenheim

Rupert Goetz
The state mental-health system has been working to provide better services to the mentally ill in the community, said hospital administrator Paul Guggenheim. The change has been dramatic, but "we are still way behind," he said.

Hospital officials cannot talk specifically about Vasquez because of privacy reasons, but said patients such as Vasquez present a formidable challenge, particularly when they are repeatedly released, then return.

The facility, hospital medical director Rupert Goetz and Guggenheim say, has shifted the focus to caring for the patients mentally, physically, medically, spiritually, "every which way," to help them recover.

But sometimes there's a "mismatch" between what the former patients need and what they get when they are released, Goetz said.

Guggenheim believes it requires support from friends, family, churches, colleagues, cultural groups, anything to help the former patient succeed.

Proper care

City prosecutors believe that Vasquez should be at the facility where he can receive treatment, rather than outside the hospital jeopardizing public safety. And a psychologist who evaluated him said he doesn't believe Vasquez is a victim of state laws or flaws in the mental-health system.

"It seems more likely to say that Mr. Vasquez is a victim of his own mental illness, which is sadly true of many cases," said Marvin Acklin, a clinical and forensic psychologist.

Still, Vasquez's lawyers believe Vasquez has been under the jurisdiction of the state longer than anyone they can recall for commission of a five-year felony.

"They can spend their whole lives in the hospital," said Tyrus Buyama, Vasquez's deputy public defender. "Just in that sense, we think it's unfair."

State Rep. Dennis Arakaki, D-30th (Moanalua, Kalihi Valley, 'Alewa), chairman of the House Health Committee, said he believes people such as Vasquez can be safely released. He cited others suffering from schizophrenia who are living in the community, although he acknowledged Vasquez may require a higher level of supervision.

"It is not a crime to be mentally ill," Arakaki said.

Buyama has filed a new request for Vasquez's release.

Crime and insanity

The cost to taxpayers of keeping patients like Lloyd Vasquez at the state hospital in Kane'ohe is about $600 a day.

Bruce Asato • The Honolulu Advertiser

Under state law, defendants acquitted by reason of insanity are not held criminally responsible for their crimes and do not go to prison. Instead, if court-appointed panels of mental-health professionals find the defendants to be dangerous, they are committed to the state hospital until they no longer pose a risk to themselves or others.

That, however, could take years — or in Vasquez's case, decades.

Although patients have been in the hospital longer for insanity acquittals for crimes such as murder, Vasquez probably has been under the health department's jurisdiction longer than any other patient with a five-year felony insanity acquittal, according to data provided by hospital officials.

The cost to taxpayers of keeping Vasquez at the Kane'ohe facility is about $600 a day.

Vasquez has a troubled history of mental problems that extends to childhood, according to his 26-year-old court file, which includes numerous reports of mental evaluations, as well as interviews with him and his sister. At age 8, for example, he was given electroconvulsive or "shock" therapy.

A year before his 1979 arrest here, Vasquez came to Hawai'i from New York City to live with a brother.

He says he ended up drinking wine and taking drugs, including marijuana, LSD and amphetamines, and was unemployed and homeless when he was arrested.

Vasquez claims he was trying to get to a hospital when he got into the van and drove away, but one of the court-appointed examiners reported Vasquez "thought his actions were being directed by God himself, directed against disciples of Lucifer."

Release denied

State hospital officials reported as far back as 1979 that Vasquez improved enough to be released. But each time he was released under certain conditions, he was brought back after violating those mandates. He stopped taking his medication, became delusional, at one point claiming to be a police officer, and threatened to kill people.

Acklin, the clinical and forensic psychologist, last year evaluated Vasquez and reported he probably has received the maximum help he can get from the hospital, but isn't likely to improve significantly.

Based on the reports from Acklin and the two other experts, Circuit Judge Marcia Waldorf last year denied his request for release under certain conditions.

Contradictions

The lanky Vasquez was polite during an interview at the hospital recently, although he had a tendency to ramble, mixed up dates and talked about his past in ways that contradicted reports from doctors and the court file.

He denied threatening to kill anyone. "All lies," he said.

When he stops medication, he does not "decompensate," as the doctors have reported. "I get hyperactive," he said.

But he is currently on medication, he told the reporter, and insisted he wants to be released.

"I have the right to liberty and the pursuit of happiness out in the community," he said. "I can become a useful member of the public."

He also said he's improved since first coming to the hospital. "I got more wiser," he said. "Now I understand the system better than I did before. I learned not to fight the system, just cruise along with them. Everything works out better. It works faster and better."

Family support

For Vasquez and other patients, the support often falls on their families.

Vasquez's older sister is willing to help. She came to Hawai'i last year and went out with her brother on day trips. "The problem is that Lloyd has been institutionalized his whole life," said Abigail Vasquez, 52, who heads a medical supply company in San Diego. "He has good days and he has bad days."

She choked back tears. "It's been a burden," she said. "I just don't know how to help him. I can't just take him out and bring him here."

The sister would like to see Vasquez first released to a care home. "In order to do right by society, you want Lloyd to prove himself. You don't want to jeopardize anybody," she said.

If he succeeds, she would take him to San Diego to live near her.

"I think he's gotten used to things don't work out. He goes back to the hospital. That's all he knows."

Release requested

A July 5 hearing has been scheduled on Vasquez's request for release.

Three court-appointed mental-health experts will evaluate him and report to Judge Waldorf, who will decide whether Vasquez can leave the facility under certain conditions, such as requiring that he take his medication and remain at a group home.

City Prosecutor Rochelle Vidinha said that as late as last year, Vasquez refused to take his medication, threatened hospital staff and acted violently, which indicates he's not ready to be released without posing a danger.

"Unfortunately, it's been this long and they still haven't reached that point with him (that he won't pose a risk)," she said.

But Buyama and Abigail Vasquez said they think Vasquez has improved, one of the issues for the court-appointed experts to review. "We're hopeful the judge will grant (the release)," Buyama said.

Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com or 525-8030.