A case for CA SB 43 - Expanding "Grave Disability."
by Catherine J Rippee-Hanson
I set out today to write a post for my brother, James Mark Rippee's birthday, April 17th, 2023. He would have been 60 had he not died on November 29th, 2022 from an untreated serious mental disorder and no-fault brain disease that included anosognosia. (Lack of insight) I thought I had a couple of ideas about what to write...in memory. However, my thoughts are still conflicted by the uncertainty of what happened, why, and what could have been.
We had not seen Mark or heard from anyone in the community for almost two weeks until my daughter and twin sister, Linda found him. Was he making decisions and changing his patterns because he was on antipsychotics or unmedicated? Had someone run Mark off from his usual spots, or was someone putting a roof over his head? Could we be happy that he cannot be found on the streets, or is he being exploited? Was he safe or needed us? When we didn't have information about where he was or his condition it was always terrifying. We hoped that the bigger picture would provide us with answers and relieve our worries, but until we have all the pieces, we couldn't be sure.
Mark told them that he was staying in a house in Vacaville with an apparent 'open' atmosphere. There were others staying or living there, but that's all we knew. He paid $600 in rent for a month, he said. Although we later found that much more had been withdrawn from his bank account. He showed them a completely shattered and worthless cell phone that had been sold to him for $200 on the street.
When asked about the living situation, he said the rent was for sleeping in the living room. But often there were so many others in the house that it would be too much "noise" and he would have to sleep in the backyard. Due to his blindness and hearing voices, Mark couldn't handle sensory overload. We could only speculate about the environment or the big picture.
After we found him in the middle of November, there was no contact of any kind for the last 10 days of Mark's life. No one spotted him and messaged us to let us know. Yes, we warned many times he would die on a Vacaville sidewalk. His death wasn't a surprise, but it was still heartbreaking to witness the consequences of our society's inaction. Four days before he died I wrote a post about just one of the many times Mark had been abused and exploited in the past. The end of that post haunts me since Mark died.
It read, "As you wonder why we aren't thankful and happy this Thanksgiving weekend for Mark having some semblance of shelter - it's because we know what is coming. And I don't think it's going to be good."
We had no way of knowing if he was safe or suffering away from our Facebook group of caring citizens and community's watchful eyes. We could only hope he was safe. He wasn't. And we still lack answers to so many questions. I don't know why he was found gasping for air on the streets of Vacaville in the middle of the night right after the Thanksgiving holiday.
Why wasn't he in that house? ESPECIALLY if he was ill... with the flu which turned into pneumonia and a UTI that left untreated turned into sepsis and ultimately... multiple organ failure?
We don't know who dropped him off at the ER with a 50% oxygen level and unable to advocate for himself. Was it a good Samaritan? One of our Facebook group members was in the ER that morning and messaged me. That is how we discovered he was in the hospital. He was combative, out of his mind, struggling to comprehend why he needed medical assistance to breathe... and refused to be intubated. The doctor accepted the request despite the fact that there was no signed DNR. Some time passed by without needed oxygen before he was induced into a medical coma and finally intubated forcibly.
We don't know what happened to Mark in the days leading up to his death. He was probably taken advantage of financially. Certainly, paying any amount of rent to someone to sleep in the living room or backyard wouldn't be considered by any means, #HousingThatHeals.
Mark once told me that when you don't have anyone to trust... you have to trust anyone. Mark sometimes said the most profound things. His words highlight the desperation of living in poverty, homeless without resources, suffering with the symptoms of psychosis - taking risks when you think you have nowhere else to turn while delusions deceive you.
It concerns me how others around him could not see he was sick. Did he beg for help only to be ignored? Why did he deteriorate to the point that he literally almost died on a sidewalk just as we repeatedly predicted? Was he walking to the hospital because no one helped him? No matter what, Mark deserved better than the fate he ultimately received. I can only hope that the tragedy of Mark's life will be a reminder to those in power to take mental illness seriously and provide the resources necessary to help those in need. Stop saying they have the freedom to choose when they don't even know they are ill. We owe it to Mark and all those like him to make sure their voices are heard and that they receive the help they need.
We must acknowledge that mental illness is a real and serious issue, and the only answer is care and treatment. We must recognize our collective responsibility to provide the support and resources necessary for those struggling with it. And most of all, we must continue to tell our stories and support legislative changes that could make all the difference for #FamiliesLikeMine. Even if I had all the answers to my questions, it wouldn't make any difference to the fact that Mark died because he was too vulnerable to indifference and apathy.
We must strive to ensure that no one else will suffer the same fate that Mark did, and that every person can have access to the resources they need to receive the care and support they deserve.
In California, that means letting your elected officials know that you want their support of legislation that might actually make a difference. One of these bills is Senator Susan Eggman's SB 43 that expands the definition of Gravely Disabled. The criteria for LPS Conservatorship or temporary holds and evaluations would take medical necessity, psychiatric deterioration, and anosognosia (lack of insight) into account for the first time here in California. It is going before the CA Senate Judiciary Committee on April 25th, 2023.
If my brother's inability to make sound decisions about his care or treatment due to his anosognosia had been taken into consideration, he would still be here with us celebrating his birthday. His anosognosia was a factor that, had it been taken into account, could have saved his life. The decompensation and deterioration were witnessed by thousands across the country as we continually gave updates and told his story as straight forward and honestly as we could. We want to ensure that no one else experiences this kind of loss due to a lack of understanding and recognition of anosognosia.
On my brother Mark's birthday, I will make this my wish. I will call, write and visit my representatives to urge them to support the CARE Act, SB 43, and #HousingThatHeals. I hope others will join me in this effort to create a better future for our nation's most vulnerable.