Free to Die in Iowa

[question everything]

The Wall Street Journal

Free to Die in Iowa
By MICHAEL JUDGE
December 22, 2007; Page A10

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On Nov. 7, at 3:57 p.m., police responded to a report of a body under the Benton St. Bridge. Upon arrival they found Sonny Anthony Iovino, a 55-year-old, mentally ill Vietnam veteran, nearly naked, dead. The Johnson County Medical Examiner determined the cause of death to be hypothermia. Local police officers had tried to get Iovino the care he needed just 48 hours before his death. But he was refused a bed at the local homeless shelter and then turned away from the Veterans Affairs Medical Center here because he was "uncooperative." After Iovino's death, a spokesman for the VA Medical Center told the Cedar Rapids Gazette, "If somebody doesn't want to be treated, you can't treat them." This is simply not the case. Given his debilitated state, the VA psychiatrist on duty could have forced Iovino to receive the treatment that might have saved his life.

Most states, including Iowa, have passed assisted outpatient treatment (AOT) laws. According to these statutes, "you must continue to take your medication or you may be committed," says Dr. E. Fuller Torrey, author of "Surviving Schizophrenia" and president of the Treatment Advocacy Center, a nonprofit dedicated to eliminating barriers to the treatment of mental illnesses. Dr. Torrey notes, however, that states often fail to use AOT laws because of strict commitment standards and poorly outlined procedures. In fact, Iowa's commitment standard is better than many states', which demand that a person be an "imminent" danger to himself or others. In Iowa, however, to be eligible for AOT a person must lack sufficient judgment to make responsible decisions concerning treatment; and be either (1) a danger to self/others or (2) unable to satisfy the need for "nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death."

When Iovino was picked up by police just two days prior to his death, he was digging up the earth with his bare hands, talking to himself, barefoot in frigid weather, and huddling near a building's exhaust vent to stay warm. He was at the very least a danger to himself. Police convinced Iovino to put his shoes back on and cited him for trespassing. They received another call a few hours later and found that he had removed all his clothing but his pants. They again helped him get dressed and sent him on his way. When called back a third time, they took him to the VA Medical Center, where he asked for medicine. When the VA did not admit him, the officers took him to the county jail, which also refused him, saying he needed immediate medical care.

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According to a study by the Justice Department last year, 56% of state prisoners, 45% of federal prisoners, and 64% of local jail inmates suffer from mental illnesses. There are now more mentally ill Americans behind bars than in hospitals. Nevertheless, civil libertarians seem more concerned with a patient's civil rights than his very survival. For example, despite a study released in 2005 by the New York State Office of Mental Health showing a marked decline in arrests, hospitalizations, incarcerations, homelessness, and threats of violence and suicide for patients under that state's "Kendra's Law," the New York Civil Liberties Union lobbied against the law's renewal that same year.

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Mr. Judge, an Iowa-based freelance journalist, is a contributing editor at the Far Eastern Economic Review.

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