Are people who still need treatment being released from psychiatric facilities in Georgia, the Atlanta Journal-Constitution questions

From The Atlanta Journal-Constitution:

Chris Pak pleaded with doctors and nurses at the state psychiatric hospital. His sister, Na Yong Pak (pictured), was still psychotic, he said. If they let her go home, he was afraid she would kill herself or someone else – their mother, most likely, the frequent target of her schizophrenia-fueled rage.

Two weeks earlier, Georgia officials had pledged to use caution in discharging patients from its psychiatric facilities. Federal investigators had sharply criticized the state for releasing patients to homeless shelters and bus stops, street corners and abandoned buildings, with little hope for continuing treatment or, in some cases, survival.

Now, on a Friday evening in January at Georgia Regional Hospital/Atlanta, Na Yong angrily refused to sign her discharge papers. She cursed the nurse and swore she would not take her antipsychotic medication.

The doctor and nurse sent Na Yong home, anyway.

“That,” her brother would say later, “is when I knew hell was going to break loose again.”

Twelve days later, after she left Georgia Regional, authorities say, Na Yong doused her mother with gasoline, struck a match, and watched her burn. Myong Hui Pak, 58, died 10 hours later.

Na Yong, 32, is in the Gwinnett County Jail, charged with murder. Her case illustrates the deficiencies that plague Georgia’s mental health system and challenges the state faces in making corrections mandated after a federal civil-rights investigation of hospital conditions.

Overcrowded and understaffed, the seven state hospitals often have released patients who are unstable, and many return to the facilities again and again. Mental health advocates say community-based services, such as group homes and outpatient clinics, are reliable alternatives, but Georgia’s spending on such care ranks among the lowest in the nation.

Even when serious flaws emerge in the system, the state often fails to correct them or even to investigate their cause.

The physician who signed Na Yong’s release papers, Walter Hill, also discharged one of Georgia Regional’s most notorious patients, James Calvin Brady. In 1990, a day after he got out of the hospital, Brady bought a gun, took MARTA to Perimeter Mall and opened fire in the crowded food court, killing one person and wounding four. Hill released Brady over the objections of a hospital psychologist who described the patient as “psychotic,” “dangerous,” and “potentially homicidal or suicidal.”

By telephone from Georgia Regional, Hill declined to comment for this story.

The Department of Human Resources, which operates the state hospitals, did not respond to requests for comment. Two days after Na Yong’s arrest, department spokeswoman Dena Smith deflected blame from Georgia Regional. “Personal responsibility of managing mental illness,” she said, “should definitely be brought into consideration.”

Georgia Regional administrators have no obligation to re-examine her treatment and discharge. State regulations would require them to consider their institution’s culpability if a patient committed suicide shortly after leaving the hospital or suffered some other harm. But criminal charges against a recently released patient, even murder charges, don’t trigger an internal investigation.

The system’s failures leave the Paks and other families to try to fill the gaps in care on their own.

Na Yong’s family understood the extent of her illness and tried to get her help, says Lawrence Lewis, her court-appointed defense lawyer. But because she had no medical insurance to pay for private psychiatric care, Lewis says, the state hospital was their only alternative and arranging treatment there was difficult.

“They really did everything they could.”

As Norcross police Detective Beverly Parnell, who investigated the murder case against Na Yong, puts it: “You really have to jump through hoops to get somebody committed. It is not an easy process to go through.”

Four months after Na Yong went to jail, her brother and father sit in a sparsely furnished apartment in Doraville. They couldn’t bear staying in the Norcross townhouse where Myong Hui was burned. A desk in the apartment holds two framed photos: one of Myong Hui, the other of Na Yong.

All her brother and father can do is mourn. “I lost two people,” Chris Pak says, “in one day.”

Chin Pak brought his family from South Korea to America in 1980 – “October 20, 1980,” to be precise, he says in a heavy accent. They settled in Columbus, where Myong Hui’s father, an American soldier, had been stationed.

Na Yong stayed in Columbus after the rest of the family moved to metro Atlanta in the 1990s. She got married, had a baby, got divorced, and strained to pay her bills as a single mother. She waited tables, served drinks in bars – whatever work she could find, her brother, Chris, says.

“She was a very nice girl,” he says. “She wouldn’t even tell us she was struggling.”

Na Yong fell behind on her rent in 2007, and was evicted. Her son went to live with his father. Na Yong came to Atlanta.

She moved in with her parents and her brother, but missed her son, Chris says. She had no job and would sleep until noon. “She felt like she had no hope.”

Her depression gradually turned darker. She yelled at people no one else could see. She would drink only Coca-Cola, but often threw nearly full cans on the floor and against the walls. She accused her mother of poisoning her food.

Soon, bruises began appearing on her mother’s body.

In the summer of 2008, Na Yong’s father and brother persuaded a judge to commit her. After one week at Georgia Regional and another at a private hospital, she came back home.

Na Yong went to jail for 29 days last September after allegedly attacking her mother. Chris decided to move Na Yong into an apartment of her own, even if he had to help pay for it. In the meantime, her violent outbursts intensified.

On Thanksgiving, Chris took his sister and mother to dinner at the Cracker Barrel on Jimmy Carter Boulevard. He says his sister began screaming, saying her mother had poisoned her food. Na Yong repeatedly struck her mother before Chris wrestled her out of the restaurant.

At home on Dec. 1, Chris says, Na Yong shoved her mother into a sharp corner of a wall. At the emergency room, as doctors stitched her head wound, Myong Hui said she had fallen.

Two days later, Chris, a loan closer for real estate lawyers, got home from work and found Na Yong alone. Their parents were at the hospital again; Na Yong had attacked her mother in the shower, beating her in the head with a cola can. Doctors used staples to close this gash.

With Myong Hui still blaming herself for her injuries, police told Chris they didn’t have enough evidence to jail his sister. Instead, they took her to Gwinnett Medical Center, and a doctor signed documents to send her back to Georgia Regional.

The Justice Department began investigating Georgia’s state hospitals in 2007 after articles in The Atlanta Journal-Constitution revealed dozens of deaths from neglect and abuse. Federal agents started at Georgia Regional.

In May 2008, the department sent a 63-page letter to Gov. Sonny Perdue, detailing the hospital’s substandard medical care, its failure to prevent assaults of patients and staff, and “egregious, systemic” errors in discharging patients. Discharge decisions often were based on “inadequate assessments,” the department said, resulting in “frequently inappropriate” releases.

Sixteen days after she entered the hospital, Na Yong went before a judge who would decide whether she could be held against her will. “She is going to kill somebody,” Chris says he told the judge, “or she will hurt herself.”

The judge questioned Na Yong about her suspicions of being poisoned. She said if her mother kept trying to kill her, not only would she beat her again, she would “do something more.”

The judge ordered Na Yong held for seven to eight weeks.

During visits at the hospital, Chris says, Na Yong still seemed delusional, and dangerous. He says he told hospital workers he thought she was suicidal.

Nevertheless, by late January, Dr. Hill decided she had improved enough after seven weeks in the hospital to go home, her medical records show. Chris delayed picking her up almost a week, hoping the doctor would change his mind. Finally, he went to get his sister Jan. 29.

Na Yong was belligerent, Chris says. When a nurse tried to hand Na Yong a small supply of the antipsychotic drug Abilify, she yelled, “I’m not taking that (expletive) medication.”

Chris says he begged the nurse to keep her in the hospital. But even after Na Yong’s outbursts and her refusal to sign discharge papers, the nurse released her. The papers showed an appointment at a Lawrenceville clinic the following week (Na Yong never went), as well as instructions for life outside the hospital: “Be careful in activities that require good skills and judgment.”

On Feb. 10, 12 days after she left the hospital, Na Yong walked from the family’s townhouse to a convenience store about half a mile away. Dressed in pink pajama bottoms, her hair unkempt, she pumped $1 of gasoline into an open cup. Security video shows Na Yong paying the clerk and, just as she turned to leave, asking for a book of matches.

Chris got the call at work.

A police detective told him his mother had been burned. Two words stuck in Chris’ mind: life threatening. Immediately, he says, “I thought of my sister.”

At Grady Memorial Hospital in downtown Atlanta, Chris saw the severity of his mother’s injuries. Third-degree burns covered 70 percent of her body. She coughed up blood when she tried to speak to his older sister on the telephone from California.

Myong Hui was on painkillers and, Chris says, knew she was going to die.

“Take care of Na Yong,” he says she told him. “Don’t hate Na Yong.”

Chris visits his sister in jail every Monday. She has lost weight, he says, and cries continually. She has told him she killed their mother in self-defense.

“When you look at her,” Chris says, “it’s like her soul is out of her body. I see in her eyes – it’s like there’s nothing in there.”

Chris is angry about his family’s double tragedy. He blames Georgia Regional.

“I gave them so many warnings. They didn’t listen. They did not take it seriously.”

On March 6, a judge ordered a psychiatric evaluation of Na Yong to determine whether she is competent to stand trial. But the evaluation probably won’t be completed until at least August, her lawyer says. There’s a waiting list for admission to the hospital that conducts the exams: Georgia Regional.