Mental health patient died in 2018 after discharge to Boston streets
Advocacy group calls her a victim of 'patient dumping'
THREE WEEKS after CaSonya King entered High Point Hospital in Middleborough for mental health treatment in 2018, she remained severely ill – disoriented, delusional, and talking to herself.
But instead of continuing to care for her or discharging her to another facility, the hospital dropped her off in Boston near a homeless shelter, against her will and without the consent of her mother and legal guardian Angela King, according to the Disability Law Center, a private, nonprofit agency that has a mandate under state and federal law to investigate abuse and neglect of people with mental illness.
CaSonya King never checked into the shelter. By the next morning, she was at a CVS six miles away speaking incoherently and buying and consuming fatal amounts of over-the-counter pain and cold medication. Thirty hours after her discharge, the 44-year-old was dead.
Angela King last week filed a wrongful death lawsuit against High Point Hospital, which is now closed; a doctor and social worker who worked there; and CVS. On Tuesday, the Disability Law Center released a devastating report detailing the immense failures of High Point Hospital to safely discharge CaSonya King.
In addition to faulting the hospital, the Disability Law Center report also slams the state Department of Mental Health, which licensed the hospital. The report says the department failed to demand answers to basic questions, then failed to require any significant reforms by the hospital. High Point Hospital has since stopped providing inpatient mental health treatment.
“This woman survived 9/11 to die at 44 on the streets of Boston in total obscurity without any meaningful justification or any accountability,” said Rick Glassman, director of advocacy for the Disability Law Center. Glassman said frustration with the investigation is the unanswered questions that remain – for which he holds the Department of Mental Health accountable.
The Disability Law Center is calling the case an example of “patient dumping,” a phenomenon where a hospital discharges someone to the streets because there is nowhere else for them to go. “I think it reflects a larger problem in the way in which we regard some people as having lives that are less deserving of compassion and care and dignity, and we treat people as if they’re less than people,” Glassman said. “To leave someone on the street, dumping them in a strange city without supports in a delusional state, I think dumping is an appropriate word for that.”
Glenda Hazard, a spokesperson for the Department of Mental Health, said the agency “is deeply saddened by Ms. King’s death, and immediately investigated the actions taken by the provider. DMH identified serious issues with the hospital’s discharge actions, conducted unannounced inspections of the facility, and required corrective action in policy and training from High Point Hospital. DMH strongly opposes the practice of patient dumping in any facility.”
High Point still operates other facilities besides the mental health hospital, and administrators did not respond to a request for comment left at one of the open facilities. Several phone numbers listed on the hospital website are no longer working. Its attorney did not immediately respond to a request for comment.
Angela King’s civil lawsuit, filed in Worcester Superior Court, seeks unspecified monetary damages from High Point; CVS; Omayra Nieves, who was the attending physician responsible for King’s mental health care at High Point; and Melanie Jette, a social worker at High Point.
The complaint does not lay out any details of their conduct. But the Disability Law Center lays out in stark detail High Point’s treatment of King.
On June 8, 2018, King was admitted to High Point Hospital, a private psychiatric facility. She had recently been discharged from another hospital to a respite home but was then committed to High Point because she was experiencing paranoia, auditory hallucinations, and agitation, according to medical records cited in the report.
At the hospital, King continued to experience severe symptoms of mental illness – yelling at auditory hallucinations, pacing, talking to herself, and showing impaired judgement. According to the report, the facility filed for a court hearing to have King civilly committed, which would mean they could keep her confined involuntarily for up to six months. However, the hospital then asked the court to postpone the civil commitment hearing and instead made plans to discharge King.
The rationale behind the discharge is unclear, according to the Disability Law Center’s report. The physician in charge wrote in her notes that King no longer required inpatient level care – but notes written by other staff chronicled little improvement throughout her stay. The Disability Law Center report says medical records show King remained “decompensated and disoriented” at the time of her discharge.
There appeared to be little actual planning for King’s discharge until June 26, when the hospital held a meeting with King, her mother, and a clinician from a respite care facility, Milford Respite. While High Point’s notes say Milford Respite would not take King at the time, both Angela King and the respite provider said Milford Respite was willing to accept King. The Milford Respite clinician, however, expressed reservations about her readiness to be discharged.
The High Point Hospital team then decided to discharge King to the Pine Street Inn homeless shelter in Boston – even though King said explicitly that she wanted to go to Milford Respite and did not want to go to a shelter. On June 27, without notifying Angela King or Milford Respite, High Point Hospital transported King to an urban neighborhood in Boston.
The report said the hospital has no records of where King was dropped off – a deficiency that the report calls “baffling.” She was given prescriptions to fill herself and the name of a mental health clinic.
She never checked into the Pine Street Inn. She did make it to a CVS in Brighton, where she purchased over the counter pain and allergy medications and ate them while making concerning statements, leading a CVS staff person to call 911. King was taken to the hospital, where she died. Her death was attributed to an accidental overdose of over-the-counter medication.
The Disability Law Center report says High Point Hospital’s discharge of King “constituted neglect and a dangerous practice that contributed to CaSonya King’s tragic death.”
High Point Hospital, the report says, ignored state and federal laws requiring hospitals to provide adequate discharge planning, including making every effort to avoid discharging someone to a shelter or the street. The report says the hospital failed to plan for King’s discharge, then decided to send her to the shelter in a rush without her or her mother’s consent – when the hospital had multiple legal options they could have used to keep her in treatment. They dropped her on the streets, far from her support system, with no assistance, according to the report.
“All of the above begs the question, why did the hospital staff seem to be in a rush to discharge CaSonya, no matter what? Why exactly was she discharged on June 27, 2018? And why was this done without notifying her guardian, her prospective community provider, or any of her other community supports?” the report asks.
King had insurance through MassHealth, and records included in the report reveal that High Point was paid only a small fraction of the services it billed the insurer for. There was a note in records from the hospitals where she was taken after her overdose saying she was discharged from High Point “after insurance ran out,” but the Disability Law Center could not confirm whether insurance played a role in her discharge.
High Point Hospital told the Disability Law Center that it could not provide any information about King’s case beyond her medical records because it no longer offers inpatient mental health treatment so no one was left on staff who had any knowledge of it.
High Point Hospital was first licensed by the state in 2015. The state blocked admissions to the hospital in August 2019. WCVB reported that the state blocked admissions into two facilities run by High Point amid concerns about patient care and an allegation of sexual assault of a patient by a staff member at a facility in New Bedford.
According to state officials, the Joint Commission, a national agency that had accredited the hospital, stripped High Point Hospital of its accreditation in July 2019. Later that month, the Enterprise reported that the Middleborough hospital was closing due to a decrease in admissions and financial losses.
Beyond the problems at the hospital, the Disability Law Center report also criticizes the state Department of Mental Health for failing to demand answers and failing to impose sanctions on High Point Hospital.
A DMH investigation, conducted in July and August 2018, concluded that High Point Hospital acted in a dangerous manner with regard to King’s treatment and discharge. But it required the hospital only to review various policies and train its employees. The Disability Law Center report says DMH did not threaten to suspend the hospital’s license unless reforms were completed and did not require the hospital to investigate whether disciplinary actions against any employees were warranted.
“In light of this tragic and senseless death, we find the Department’s remedial action to be vague and incomplete,” the report said. “This lack of rigorous oversight devalues the lost life of CaSonya King and undermines the Department’s core mission.”The Department of Mental Health says it did conduct unannounced inspections of the facility between June 2018 and July 2019, in addition to requiring corrective actions on policies and training. High Point created a new policy on discharges to shelters after the DMH investigation.
High Point continues to operate multiple substance abuse treatment facilities, licensed by the Department of Public Health, in New Bedford, Brockton, Plymouth, and elsewhere.