Western Psych shooting rampage prompts changes
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Allegheny County's Department of Human Services is clarifying for physicians its role in the process of involuntary commitments to mental facilities as questions remain about reaction to a troubling encounter John F. Shick had with UPMC staff less than a month before his March 8 shooting rampage at Western Psychiatric Institute and Clinic.
In a two-page memo detailing state law, DHS's Behavioral Health Office noted that while county mental health delegates can authorize an involuntary commitment of someone deemed dangerous to themselves or others, they cannot override the authority of a physician or a police officer from doing the same. Such an involuntary commitment is known as a "302," named for the authorizing section number in the state's Mental Health Procedures Act.
The actions and authority of mental health delegates have come under scrutiny by the county district attorney's office, which said its probe of the Western Psych attack found at least one incident in which it appeared a physician's attempt to involuntarily commit Shick was blocked by a county delegate.
In an emailed response to questions from the Pittsburgh Post-Gazette, which obtained the memo being distributed to hospitals and mental health agencies, DHS said: "If we become aware of any confusion regarding processes or procedures, we clarify and educate those involved. As a result of the questions raised after the incident at WPIC, it became increasingly clear that we needed to issue a 302 clarification throughout the system regarding the county's role in the commitment process by physicians."
District Attorney Stephen A. Zappala Jr., whose office is conducting a wide-ranging investigation into the Shick mass shooting, said Friday he was pleased to see the clarification. He said it states the law correctly and eliminates apparent confusion that 302 commitments by doctors and police officers must be approved by county delegates.
Mr. Zappala said he had met with county Executive Rich Fitzgerald to discuss his concerns about misconceptions regarding the county's role in the involuntary commitment process that his investigation of the Shick shooting had uncovered.
He said he found it troubling, given several opportunities and the presence of legally sufficient criteria, that no one involuntarily committed Shick before the 30-year-old schizophrenic shot six people, one fatally, in Western Psych, where police killed him. Mr. Zappala said he was concerned about it "as a legal matter and as a practical matter, given Mr. Shick's history. He was 302'd twice in New York state and nobody was hurt; he was 302'd in Oregon and nobody was hurt."
According to a review of Shick's medical and psychiatric records prepared for the district attorney by Bruce A. Wright, chairman of the psychiatry department at St. Clair Hospital, on Jan. 10 Shick had an encounter with a "crisis clinician" and a registered nurse. During that interaction, according to the summary, Shick was aggressive, rambling, difficult to engage, belligerent, verbally abusive, unstable and agitated, Mr. Zappala said. He also exhibited "bizarre" behavior and made a "comment about beating up a medical staff member."
He found it troubling that despite notations in the medical records indicating behaviors consistent with the need to institutionalize Shick that it was not clear anyone sought to do so.
On Feb. 10, Shick appeared at the Shadyside Family Health Center with a baseball bat. UPMC said he used it as a cane and was nonthreatening, but prosecutors said he was "menacing."
On Feb. 20, Shick made a second visit to Shadyside Family Health Center with a bat. UPMC has said that its internal security dealt with Shick but did not call police.
That day, Mr. Zappala said, a doctor contacted a county mental health advocate to say that Shick should be involuntarily committed. However, a notation in the medical records, presumably by the doctor, indicated the advocate didn't agree, that Shick was "refused 302 because not an imminent threat to self or others. Has not specifically threatened anybody."
A source who asked to remain anonymous identified the physician who sought the involuntary commitment as Jason D. Kirby. Dr. Kirby declined comment.
First Published June 16, 2012 12:00 am