Petaluman recounts ‘mortifying’ experience at Santa Rosa Kaiser amid mental health crisis

Editor’s Note: The following story discusses events that may be triggering to those experiencing mental health difficulties. Please see the list of mental health resources at the story’s end. Because of the sensitive nature of the story, we are not providing Miles’ last name.

Miles was in the grips of a serious mental health crisis.

The 20-year-old Petaluman, who has struggled all his life with anxiety, mania and depression, had tried in late August to make a therapy appointment with his health care provider, Kaiser Permanente. But there were no appointments available for weeks to come.

This was in part because Kaiser mental health clinicians had begun a 10-week strike, leading to hundreds of canceled appointments for behavioral health services throughout Northern California in a system the strikers said was already understaffed and unmanageable.

So on a particularly bad day in early September, as Miles’ symptoms spiraled out of control, he and his mother, Lori, went to Santa Rosa to check him into the Kaiser Permanente emergency room there – passing through striking health care workers’ picket lines to do so.

“I had previously been hospitalized out of that emergency room four times when I was younger,” Miles said in a recent interview. “So for the fifth time, I was like, ‘I know they can do it well. I’ve had alright experiences.

“But it didn’t end up going well at all. It was mortifying.”

In fact, he said it was one of the most terrifying nights of his life. Miles, despite being deemed an immediate threat to himself and placed under 72-hour surveillance, managed to obtain a razor blade and slashed his own throat.

‘Additional steps’

The incident happened as Kaiser’s Northern California mental health workers were holding a more than two-month-long strike, which ended in October.

At the same time, state health officials had been called to investigate the level of care the Santa Rosa emergency room was providing, after reports of at least two attempted suicides came through the same weekend that Miles checked into the emergency room.

According to a statement from Kaiser Permanente provided by Adriann McCall, a Kaiser Permanente media liaison, “Out of respect for patient privacy, we cannot provide information about an individual patient.”

The statement said the California Department of Public Health spent an entire day reviewing emergency department processes, consultations, safety protocols, coverage, and care transitions for patients undergoing treatment for psychiatric conditions, and that they were “recognized as thorough and compliant.”

“Patient safety in our Emergency Department is our priority and an area of extreme focus for us, especially in terms of those who may harm themselves,” the statement said.

“Over the past few years, we have taken additional steps to strengthen our detailed protocols to assure self-safety, which includes appropriate monitoring of all patients at risk of harm, environmental and structural safety enhancements, increased security, metal detector wanding, and immediate action with escalation processes in place at all times.”

The statement also said Kaiser’s work was recently reviewed and validated by the Joint Commission, an independent body that evaluates and accredits health care organizations, “whose comprehensive accreditation survey includes hospital suicide prevention strategies and procedures.”

Living with bipolar disorder

Miles was diagnosed with bipolar disorder at age 18, but said he has known anxiety, depression and bouts of mania for as long as he can remember. His symptoms are not necessarily caused by any particular event, he said.

“It’s kind of hard for me to differentiate a time I never felt that way,” Miles said. “It’s always just kind of been there.”

He said he “struggled a lot with really bad bouts of depression and then really extreme mania. Growing up with that, with no answers, was just really difficult.”

He described his depression as a black hole that forces him into a darkness with no end point and where he is his own worst enemy. As for the mania, Miles said it resembles a “fever-like state” where he loses control of his senses and decision-making ability.

“It’s not good. I’ll go days on end without talking to any of my friends,” he said, adding that mania is one of the most difficult things for him to deal with. “You just lose track of yourself.”

But what can be even worse than the symptoms themselves is the shame that comes with them.

“I feel incredibly embarrassed that my brain works the way it does, because it really is still so stigmatized,” Miles said.

That’s why in late September, when his mania started to spiral once again and he couldn’t see a therapist anytime soon, Miles decided to take a wait-and-see approach.

“How I work internally still with my mental illness is that I’ll just kind of sit and seethe with (my symptoms). I won’t really vocalize how I’m struggling,” Miles said. “I just don’t want to feel like I might inconvenience someone or that they need to be responsible for how I’m doing.”

Two weeks later, nothing got better, leading Miles to think that going to the emergency room would be the best option to alleviate his situation.

At the hospital

“We got to Kaiser in Santa Rosa and they were really busy, really busy,” said Miles’ mother Lori, speaking in a phone interview less than a week after he went to the hospital. “And I’ll give them that. I was in the medical profession and I get it. I absolutely get it.”

After evaluating Miles, caregivers determined he was a “5150,” the number of the section of California’s Welfare and Institutions Code for when a patient is deemed to pose an immediate danger to themselves. Under state law, it allows health professionals to place the patient under emergency 72-hour monitoring.

“They assigned him a security guard who was sitting there, sat there with us for an hour with a metal detector,” Lori said. “Then, they tell me that I have to go wait in the waiting room because they’re going to go put him in a chair in the hallway, or a gurney in the hallway, and I can’t sit there with him. Just the security guard can.”

So Lori proceeded to the waiting room, where she stayed patiently for hours before being sent home to wait for an update call on Miles’ status. That call didn’t come until nearly 24 hours later, she said.

Meanwhile, according to Miles, the guard stationed with him never did use his metal detector.

“In the bag that I had brought, I had a journal, and I think it’s common for people who have a history of self harm to hide things they use to do that with. And I do that, I have a very large history of that,” Miles said.

“And in my journal, I was hiding razor blades that I had since forgotten about but were still in there nonetheless. And what I can only assume happened – because they weren’t taken from me, because they weren’t found – I had seen them and it, in my manic state, triggered me.”

Being in a manic state, the next thing Miles remembered clearly was the deep gash in his throat, and the panicking hospital staff discovering what had happened.

Miles said it was midnight at that point, and though the cut wasn’t life-threatening, a doctor advised that he needed stitches. But Miles didn’t see anyone again to get those stitches for six more sleepless hours, he said.

“It was just the longest six hours of my entire life,” Miles said. “I was left alone in the room. No nurse came in to talk to me. At that point I was left alone, I think, because I might have been regarded as a danger to others. I don’t know, but it sorely did hurt because I knew I wanted to talk to people at that point in time, but I didn’t get that.”

What also disappointed him was that hospital staff gave him Seroquel, a medication used to treat mood and mental health conditions. It also was known to give Miles negative side effects, such as extreme drowsiness and difficulty breathing.

He said he had directed medical staff not to give it to him at the time of checking in, when they ask patients if they are allergic to any medications.

“It’s the one thing I told you not to do and you’ve done it,” Miles said. “I felt out of loop for the next week, I couldn’t remember the time or the date. And I’m sure the stress on top of that wasn’t helping. It was just all around very frustrating. It was terrifying.”

Asked about this incident, Kaiser representative McCall reiterated Kaiser’s statement that they will not comment on specific cases.

After a day at Kaiser, Miles was transferred to a stabilization facility, also in Santa Rosa, where he stayed for two days before going to St. Francis Memorial Hospital in San Francisco for three weeks. Miles said after the incident in the Santa Rosa Kaiser hospital, his status was upgraded to a “5250,” which extended his holding period to at least two weeks.

Strike ended

On Oct. 21, Kaiser came to a four-year agreement with its workers union that “will enable greater collaboration aimed at improving access to mental health care,” the provider said in a statement at the time.

“We appreciate our therapists’ confidence in this agreement, which addresses the concerns they expressed, while upholding Kaiser Permanente’s commitment that any agreement must protect and enhance access to mental health for our members,” the Kaiser statement said. “We are glad to have all our employees back, caring for their patients.”

Not all details of the agreement were made clear, such as whether Kaiser would guarantee weekly therapy to members in need – something Miles said might have made for a much better experience during his recent episode.

“I don’t benefit from irregular, monthly therapy. I would do better under weekly therapy,” he said.

Now discharged from St. Francis and back in Petaluma, Miles is looking to start his first semester at Santa Rosa Junior College as a nursing student. His dream of becoming a medical professional was inspired by his own experiences – not only with mental health, but physically as well, after growing up with an injury caused at his birth that eventually led to the amputation of one of his arms.

“Some of the best times I’ve had, medically, has been with my nurses, getting to know my nurses,” he said.

“People deserve adequate, equal health care, and having been on the other side of not receiving it, has made it glaringly obvious that there’s work that needs to be done.”

Amelia Parreira is a staff writer for the Argus-Courier. She can be reached at amelia.parreira@arguscourier.com or 707-521-5208.