Ill man's suicide raises questions for Capitol Hill boarding home

Clyde Keith Bugher's jump to his death from his room at a Seattle boarding home for the mentally ill has provoked accusations from a state watchdog and questions from his mother.

The state Department of Social and Health Services conducted an investigation of the Oct. 7 death at Spring Manor on Capitol Hill, halted new admissions and ordered it to make changes to comply with the law.

It's not enough, says the state's long-term-care ombudsman.

"I want the administrator investigated for criminal neglect. They need to be held accountable," said ombudsman Louise Ryan, who plans to hold a news conference today about her concerns.

"They knew what was going on with this person. They serve mentally fragile people."

As ombudsman, Ryan can't enforce law, but she can investigate and negotiate problems on behalf of the roughly 62,000 residents in Washington's long-term-care facilities.

Spring Manor, at 1103 16th Ave., is one of four boarding homes operated by Community House Mental Health Agency, a nonprofit corporation, that are under contract with King County to house mentally ill people on Medicaid.

Community House is working through the current difficulties with the state and county "to make sure we meet the needs of clients who receive services in our facilities and doing that with the best quality we can," said board president Geoff Austin.

Bugher's mother asked Harborview Medical Center why her son was not admitted for observation, given that he was sent there three times for threatening to kill himself in the days before he did so.

He also had a long record at the hospital and had been committed before, Helen Cahan said.

"If they'd admitted him through the hospital, they would have gotten him OK before they released him," she said.

Harborview's chief of psychiatry, Dr. Peter Roy-Byrne, said Bugher had calmed down after being evaluated for a few hours in the emergency room and had said he was not suicidal.

He also refused to admit himself, so legally the hospital could not hold him, Roy-Byrne said.

"The law does not allow someone to be hospitalized based on what they've done a few hours or a few days ago."

Bugher had housing, a case manager and an outpatient psychiatrist and was sent back with a treatment plan, Roy-Byrne said.

Cahan said she has to be satisfied with that answer but believes the law is administered "too far toward civil rights and not enough for the protection of the patient and public."

Cahan said her son, who was 47, suffered from schizophrenia, was unable to keep a job, was evicted from apartments, refused off and on to take his medication and twice threatened to hurt her.

Bugher was stable when he voluntarily moved into Spring Manor in February, but by September, he had started to refuse medications.

The staff noted he was getting "markedly thinner and giving bizarre looks," according to the state's investigation report.

It said his mother called Spring Manor staff on Oct. 2 "very upset," saying her son was "on the verge of doing something drastic."

From Oct. 2 through the early morning of Oct. 7, Spring Manor staff sent Bugher, who kept threatening suicide, to hospital emergency rooms for evaluation — three times to Harborview and once to Swedish Medical Center, according to the state. It said he was sent back each time to Spring Manor, where there was no specific follow-up monitoring, according to the state report.

On the afternoon of Oct. 7, he jumped to his death, appearing to have slashed his wrists beforehand.

After investigating, the state told Spring Manor it must assess all residents for suicidal ideas or behavior, develop a safe medication-dispensing system and make sure all staff retake mental-health training and that the physical environment is safe.

Community House's attorney says a boarding house provides a safe place but cannot monitor individuals round the clock.

"An individual who is suicidal needs to be in a system where they can have that 24-hour monitoring and that would be in Western State Hospital or any other involuntary-treatment facility which could retain them," said Carla DewBerry.

Ryan insists more improvements are needed.

In her view, the bigger problem is King County's failure to make Community House Mental Health deliver better care at some of its homes near downtown Seattle.

"Just the physical environment of these places is disgusting," Ryan said. "They've been that way for years."

King County also is investigating Bugher's death. In March, the ombudsman sent a letter of concern about Community House boarding homes in Seattle to the director of the state's Residential Care Services, a part of DSHS that oversees long-term-care facilities.

Ryan complained of unsanitary conditions at certain homes, including reeking urine odor and rampant cockroaches. In response, the director said the homes had recently been inspected and DSHS was monitoring their compliance.

The ombudsman still isn't satisfied. "This suicide tipped me over the edge," she said. "It didn't have to happen."

In addition to the criminal investigation, she wants Spring Manor's board of directors held accountable, an independent consultant to assess the well-being of residents, better staffing and physical improvements at some of the homes.

Bugher's mother hopes that by bringing her son's story to the attention of enough people, funding for mentally ill people may be improved.

Marsha King: 206-464-2232 or mking@seattletimes.com