SharonBates
10-03-2005, 10:41 PM
Star-Telegram
October 3, 2005 Monday FINAL EDITION
Woman died in jail after JPS refused admission
BYLINE: By Jennifer Autrey; Star-Telegram Staff Writer
BODY:
Tiffany Dean and her mother, Connie Jaynes, are still looking for answers
after Dean's sister, Christi Ball, died in the Tarrant County Jail last October.
"Somebody made the ultimate call to turn her away" from John Peter Smith
Hospital, said her sister, Tiffany Dean, left.
Christi Ball, above in her high school graduation photo, died in the Tarrant
County Jail.
Jailers had watched her frantic distress for five days. Stopping up the
toilet to flood her cell. Trying to hang herself with her gown. Announcing that
she was pregnant with Jesus' child.
At 10:15 p.m. that Thursday, though, Christi Ball was resting, snoring even,
with her back against the door. Things were finally peaceful in cell 24, pod
63D, of the Tarrant County Correction Center.
But when a sheriff's officer checked on Ball a half-hour later, the snoring
had ceased. Another officer opened the cell door. Ball slumped into the doorway.
Blood oozed from her mouth. She was naked, soaked in urine, not breathing.
An ambulance was summoned, but doctors pronounced Ball dead at John Peter
Smith Hospital at 11:45 p.m. on Oct. 21, 2004. She became a statistic: one of 10
Tarrant County Jail inmates to die that year.
Ball had no criminal record. She was accused of only one crime: refusing to
leave JPS, where she was seeking help.
Could she have been saved? Her family says there were so many chances that
slipped away. If only JPS had committed her, rather than arrested her. If only
Mental Health Mental Retardation of Tarrant County had put her back on her
medication.
Perhaps even with the best of care, she would have died. An autopsy found
that Ball, who was 35, died of an inherited heart defect that had never been
detected.
But those who loved Ball are tormented by the thought that she was put at
risk by her arrest and the minimal care provided by JPS. At the least, they say,
she might have been spared the anguish of her final days. Instead, she was
isolated from her family, unable to even ask for them because she was in the
grip of the mania that comes with bipolar disorder.
"JPS put a bond against her," said her sister, Tiffany Dean. "Somebody there
made that call. Somebody made the ultimate call to turn her away."
Because Ball's father, Michael Wayne Dean, consulted an attorney to look into
his daughter's death, JPS officials would not discuss the hospital's treatment
of Ball.
But JPS spokeswoman Drenda Witt said that every person, regardless of what he
or she may have done, receives medical care. Someone is arrested only if the
person refuses to leave after receiving medical care, she said.
The October spiral
Ball, born Christi Michele Dean, had just finished her freshman year at Texas
Wesleyan University when she first showed signs of mental illness in 1989.
Her younger sister, Tiffany, was the first to notice. Her parents didn't
believe her. Christi had always been the perfect child: smart, organized. She
had graduated seventh in her class at Richland High School just two years
before.
But as time wore on, the symptoms became too powerful to ignore. Her manic
phases were punctuated with combative moments, wild spending and grandiose ideas
of what might be accomplished.
With medication, Ball was able to complete her college degree in biology, get
married and hold down a job in a food lab.
But every few years, the sickness would wreck her life. In one cycle, her
marriage shattered.
Each time, doctors would stabilize her, and Ball's mother and grandmother
would help her rebuild her life. But with each recovery, a little bit of the
sweet Christi they knew as a child would be gone.
Ball's relatives could tell she was getting sick whenever she started calling
around the clock.
The pattern churned up again in early October. Ball began hinting that she
might stop taking her psychiatric medication so she could get pregnant, even
though her relatives counseled her against ever having a child.
On Oct. 4, she visited MHMR's Mid-Cities office in Bedford, complaining of
lightheadedness, irritability and mood swings. Doctors adjusted her medication.
Three days later she was back, and her meds were adjusted again.
By then, Ball was in full manic mode. On Oct. 11, she sent her relatives into
an uproar when she announced that she was getting married and having a child.
She told them she had moved in with a 73-year-old who lived in a retirement
community.
She had also gone on a $6,000 credit-card spree at Neiman Marcus for the
wedding and charged hundreds more at a day spa where she had her armpits waxed
and her eyebrows shaped.
On Oct. 12, MHMR adjusted her meds a third time.
Seeking help
Ball began her odyssey to area hospitals with a visit to Harris Methodist
H.E.B. that same day, complaining of lightheadedness.
She looked disheveled. When a doctor hinted that she was manic, Ball got
angry, said her mother, Connie Jaynes.
"She was wanting the doctors to convince us that there was nothing wrong with
her," said Jaynes, who met her at the emergency room. "Well, we knew when she
was sick."
The next day, Ball sought help at Baylor Regional Medical Center at Grapevine
for the lightheadedness. Her blood pressure and heart rate were up. A nurse
noted "hypermania." Ball refused treatment and left.
The next evening, Ball arrived at hospital No. 3: Baylor Medical Center at
Southwest Fort Worth.
Ball refused treatment but also refused to leave. Just after midnight, the
hospital called Fort Worth police. When Officer M. Kuzenka arrived, he urged
Ball to go -- and to take the plants she had brought to the emergency room.
Ball's reply: "I will kill you and the people inside this hospital."
Kuzenka shot her legs with his Taser to get her into his squad car. Then he
took her to yet another facility: John Peter Smith, the county's public
hospital. In the early hours of Friday, Oct. 15, she was sent to the psychiatric
unit on the 10th floor.
First appeal to JPS
"I am Jesus Christ Almighty and you will burn in ****. You don't know who you
are detaining," Ball screamed.
At JPS, Ball charged a nurse, pinched a mental health technician and
attempted to wrestle police to the floor, according to medical records.
JPS staff injected her with medicine in her right hip to try to control her,
then placed her in seclusion.
After about 90 minutes, doctors told Ball she could be released from
seclusion. Apparently, she was supposed to leave, although terms of her release
were not included in paperwork the Star-Telegramobtained from the hospital.
Instead of going home, Ball got on the phone. Then she took off her clothes.
Less than three hours later, she was back in seclusion.
A little before 9 a.m., the hospital discharged her again -- even though Ball
told JPS officials that she wanted to be in a hospital somewhere and that she
had no place to live.
To make sure she stayed away, an officer with the JPS Police Department
escorted her from the psychiatric unit and gave her a warning ticket for
criminal trespassing.
5 hospitals in 2 days
Fort Worth police gave Ball a ride to her mother's office that Friday
morning. But her mother was home in Decatur. Co-workers called her, but they
also called an ambulance.
Ball was taken to her fifth hospital in two days: Baylor All Saints Medical
Center at Fort Worth.
"I can speak all languages," Ball told the Baylor staff.
Once again, Ball refused the offered treatment and left sometime that
afternoon.
In the meantime, Jaynes was frantically trying to get her daughter committed
to a psychiatric hospital. She failed. Ball's relatives were told that all the
judges had already left for the weekend. What's more, Jaynes was told, it wasn't
obvious that Ball could hurt herself or others -- the criteria for involuntary
commitment.
At JPS, "they treated her just enough to get her stabilized a little bit.
That's what hurt us as far as getting a mental health warrant," Jaynes said.
At about 8 p.m., Ball was picked up by a MedStar ambulance at a hotel that
had complained about a psychotic woman. MedStar took Ball back to Baylor All
Saints at Fort Worth.
Within 90 minutes, Baylor called Fort Worth police to report that Ball was
threatening other patients. When an officer arrived, Ball told him that if she
was not seen by the hospital staff, she would punish him.
"I'll kick your ***, too," she said.
Fort Worth police took her into custody, transported her to JPS hospital and
filled out an application for her mental detention there.
For the third time that day, JPS ordered Ball into seclusion. A note in the
medical record explained what happened: "Patient attempted to wrestle staff to
floor. Pt. charged toward staff in search room, then sat down on floor, refusing
to dress after disrobing."
Later that night, the hospital discharged Ball again, with advice to follow
up with MHMR. Apparently, she again refused to leave.
At 1:33 a.m. Saturday, Oct. 16, almost 24 hours after she had first visited
JPS, the hospital's police force gave her another warning ticket for criminal
trespass and showed her the door.
A trip to jail
At 6:30 a.m. Saturday, an ambulance was called to a Fort Worth department
store. MedStar employees found Ball inside, next to a broken glass door. She
said she was pregnant and needed to get clothing for the baby God gave her.
MedStar took her back to JPS.
Not long after, Fort Worth and JPS police were called to the emergency room
to deal with a combative woman. JPS officer Christopher Jolly wrote that he
found a woman "that was yelling and cursing at the officer and stating, 'I'm
having God's baby and that I need to leave.' "
The officers took Ball to the psychiatric unit, this time for a voluntary
commitment, Jolly wrote. That might have saved her, her relatives believe.
But the staff turned her away, telling Jolly that she had just been released.
"The subject was then escorted off the property and advised that she was not
to return to this location unless it was for medical attention," Jolly wrote.
Ball whipped around. "I am 12 months pregnant," she said. God informed her to
have her baby sometime that night at JPS, she told them.
At that, Jolly arrested Ball, citing her with criminal trespass.
He took her to the Tarrant County Jail and filled out a referral form for
MHMR of Tarrant County, which has the mental health contract for inmates.
Hospital officials declined to comment on why Ball wasn't committed. But Witt
described the circumstances that the hospital might consider committing patients
against their will:
"The involuntary admission criteria to the inpatient psychiatric unit is
based on the determination by a physician that the patient has a valid
psychiatric diagnosis that cannot be managed in an outpatient setting and is
dangerous to self or others," she wrote.
Naked in a single cell
Ball was booked and taken before a magistrate judge, who advised her of her
rights and set bail at $2,500. Ball refused to sign the paperwork.
A second form, Request for Appointed Counsel, was also not signed. It had a
notation: "unable to understand."
At the jail, Ball went through a medical screening that JPS conducts as part
of its contract to provide medical care for inmates. Scrawled across the form's
boxes is this note: "Unable to get any answers from patient."
Ball was assigned to an individual cell in general population, with a
recommendation that MHMR follow up.
That afternoon, during the hour inmates can visit the day room, Ball came out
of her cell -- naked -- and went to the phone.
Sheriff's officers told her to put her uniform on.
She cried, "Never!"
The next day, logs show that Ball was yelling incoherently. The sheriff's
jail staff filled out another request for mental health services.
On Monday, Oct. 18, Ball's relatives -- panicked that they hadn't heard from
her in 48 hours -- tried to file a missing persons report. Fort Worth police
checked the jail logs and found her name.
Ball's sister called the jail and talked with an MHMR caseworker. She told
the caseworker that Ball had probably been off her medication for at least four
days and that her relatives wanted to help her.
The caseworker said that Ball would have to sign a signature card before
relatives could see her -- something she had so far been unable to do. But he
assured Dean that Ball would be safe, that she would see a doctor and get her
medications.
"The only reason we did not take her out is because we thought she would get
the help she needed," Jaynes said.
Later that day, jailers found Ball lying faceup on the floor with blood
coming out of her mouth, the result of a 20-second seizure.
Her last day
On Tuesday, Oct. 19, Ball was moved to the jail infirmary -- run by JPS --
for evaluation. The next day, she was sent back to her pod.
"Doesn't need medical, per Dr. Green," was a notation on her patient history.
Medical records also say that she appeared disoriented.
"Doesn't know why she is here," the history said.
Back in her pod, Ball started tearing her paper uniform and wrapping the
pieces around her neck, abdomen and ankles. Sheriff's officers called the code
for a suicide attempt and placed her on enhanced supervision.
Later that day, Ball was visited by a MHMR psychiatrist, who wrote a
prescription to address the mania. A psychiatrist saw her again Thursday, Oct.
21, after she was found with feces all over her bed.
"Staff reports that she has been refusing Psych meds," someone noted in her
chart.
The psychiatrist wrote more prescriptions for agitation and a prescription
for Haldol -- a medicine that Ball's relatives said she was allergic to.
"Though disorganized, appears less confused, improving," the MHMR doctor
noted.
Caseworkers didn't force medication on her -- they only do that in extreme
circumstances, a spokesman said.
A few hours later, Ball was found lifeless.
The what-ifs
Ball's relatives cannot help but wonder what might have happened had she
received the help she needed.
They learned from the coroner's report that she died of hypertrophic
cardiomyopathy, an inherited defect that causes thickening in the lining of the
heart. But they wondered whether her uncontrolled mania added to the stress on
her heart.
Dr. Eric Popjes, a cardiologist at Penn State Heart and Vascular Institute in
Hershey, Pa., said that stress can exacerbate symptoms of the disorder. Stress
can also cause abnormal rhythms.
But no one knows whether a link exists between manic behavior and the
likelihood of death from the condition, said Dr. Barry Maron, director of
Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute
Foundation.
"Whether that did it or not, you know, anything is possible. Is it probable?
There would be no way to know," Maron said.
Ball's relatives also wonder why MHMR didn't work to get her out of jail and
into a psychiatric facility.
But that process requires a lawyer, and Ball was never assigned one.
Sonja Gaines, chief of mental health services at MHMR of Tarrant County, said
she doesn't know what else could have been done for Ball.
"This is not to minimize her death," Gaines said. "We were dismayed with her
death. But we have psychotic people in the jail, especially with such limited
state hospital space. On any given day, you might have several psychotic people
there. She's not the sickest person we've seen."
In the end, Ball's relatives believe that her fate was sealed by JPS'
decision not to keep her in the psychiatric ward.
Ball was sick enough to deserve help, her relatives said, and she never got
it.
IN THE KNOW
ONLINE EXCLUSIVE
See for yourself some of the e-mails and other correspondence the
Star-Telegramobtained for this project.
Candid messages by doctors, nurses, JPS officials and representatives of the
Sheriff's Department are on the Star-TelegramWeb site. The complete documents
are presented so that readers can see the full context.
October 3, 2005 Monday FINAL EDITION
Woman died in jail after JPS refused admission
BYLINE: By Jennifer Autrey; Star-Telegram Staff Writer
BODY:
Tiffany Dean and her mother, Connie Jaynes, are still looking for answers
after Dean's sister, Christi Ball, died in the Tarrant County Jail last October.
"Somebody made the ultimate call to turn her away" from John Peter Smith
Hospital, said her sister, Tiffany Dean, left.
Christi Ball, above in her high school graduation photo, died in the Tarrant
County Jail.
Jailers had watched her frantic distress for five days. Stopping up the
toilet to flood her cell. Trying to hang herself with her gown. Announcing that
she was pregnant with Jesus' child.
At 10:15 p.m. that Thursday, though, Christi Ball was resting, snoring even,
with her back against the door. Things were finally peaceful in cell 24, pod
63D, of the Tarrant County Correction Center.
But when a sheriff's officer checked on Ball a half-hour later, the snoring
had ceased. Another officer opened the cell door. Ball slumped into the doorway.
Blood oozed from her mouth. She was naked, soaked in urine, not breathing.
An ambulance was summoned, but doctors pronounced Ball dead at John Peter
Smith Hospital at 11:45 p.m. on Oct. 21, 2004. She became a statistic: one of 10
Tarrant County Jail inmates to die that year.
Ball had no criminal record. She was accused of only one crime: refusing to
leave JPS, where she was seeking help.
Could she have been saved? Her family says there were so many chances that
slipped away. If only JPS had committed her, rather than arrested her. If only
Mental Health Mental Retardation of Tarrant County had put her back on her
medication.
Perhaps even with the best of care, she would have died. An autopsy found
that Ball, who was 35, died of an inherited heart defect that had never been
detected.
But those who loved Ball are tormented by the thought that she was put at
risk by her arrest and the minimal care provided by JPS. At the least, they say,
she might have been spared the anguish of her final days. Instead, she was
isolated from her family, unable to even ask for them because she was in the
grip of the mania that comes with bipolar disorder.
"JPS put a bond against her," said her sister, Tiffany Dean. "Somebody there
made that call. Somebody made the ultimate call to turn her away."
Because Ball's father, Michael Wayne Dean, consulted an attorney to look into
his daughter's death, JPS officials would not discuss the hospital's treatment
of Ball.
But JPS spokeswoman Drenda Witt said that every person, regardless of what he
or she may have done, receives medical care. Someone is arrested only if the
person refuses to leave after receiving medical care, she said.
The October spiral
Ball, born Christi Michele Dean, had just finished her freshman year at Texas
Wesleyan University when she first showed signs of mental illness in 1989.
Her younger sister, Tiffany, was the first to notice. Her parents didn't
believe her. Christi had always been the perfect child: smart, organized. She
had graduated seventh in her class at Richland High School just two years
before.
But as time wore on, the symptoms became too powerful to ignore. Her manic
phases were punctuated with combative moments, wild spending and grandiose ideas
of what might be accomplished.
With medication, Ball was able to complete her college degree in biology, get
married and hold down a job in a food lab.
But every few years, the sickness would wreck her life. In one cycle, her
marriage shattered.
Each time, doctors would stabilize her, and Ball's mother and grandmother
would help her rebuild her life. But with each recovery, a little bit of the
sweet Christi they knew as a child would be gone.
Ball's relatives could tell she was getting sick whenever she started calling
around the clock.
The pattern churned up again in early October. Ball began hinting that she
might stop taking her psychiatric medication so she could get pregnant, even
though her relatives counseled her against ever having a child.
On Oct. 4, she visited MHMR's Mid-Cities office in Bedford, complaining of
lightheadedness, irritability and mood swings. Doctors adjusted her medication.
Three days later she was back, and her meds were adjusted again.
By then, Ball was in full manic mode. On Oct. 11, she sent her relatives into
an uproar when she announced that she was getting married and having a child.
She told them she had moved in with a 73-year-old who lived in a retirement
community.
She had also gone on a $6,000 credit-card spree at Neiman Marcus for the
wedding and charged hundreds more at a day spa where she had her armpits waxed
and her eyebrows shaped.
On Oct. 12, MHMR adjusted her meds a third time.
Seeking help
Ball began her odyssey to area hospitals with a visit to Harris Methodist
H.E.B. that same day, complaining of lightheadedness.
She looked disheveled. When a doctor hinted that she was manic, Ball got
angry, said her mother, Connie Jaynes.
"She was wanting the doctors to convince us that there was nothing wrong with
her," said Jaynes, who met her at the emergency room. "Well, we knew when she
was sick."
The next day, Ball sought help at Baylor Regional Medical Center at Grapevine
for the lightheadedness. Her blood pressure and heart rate were up. A nurse
noted "hypermania." Ball refused treatment and left.
The next evening, Ball arrived at hospital No. 3: Baylor Medical Center at
Southwest Fort Worth.
Ball refused treatment but also refused to leave. Just after midnight, the
hospital called Fort Worth police. When Officer M. Kuzenka arrived, he urged
Ball to go -- and to take the plants she had brought to the emergency room.
Ball's reply: "I will kill you and the people inside this hospital."
Kuzenka shot her legs with his Taser to get her into his squad car. Then he
took her to yet another facility: John Peter Smith, the county's public
hospital. In the early hours of Friday, Oct. 15, she was sent to the psychiatric
unit on the 10th floor.
First appeal to JPS
"I am Jesus Christ Almighty and you will burn in ****. You don't know who you
are detaining," Ball screamed.
At JPS, Ball charged a nurse, pinched a mental health technician and
attempted to wrestle police to the floor, according to medical records.
JPS staff injected her with medicine in her right hip to try to control her,
then placed her in seclusion.
After about 90 minutes, doctors told Ball she could be released from
seclusion. Apparently, she was supposed to leave, although terms of her release
were not included in paperwork the Star-Telegramobtained from the hospital.
Instead of going home, Ball got on the phone. Then she took off her clothes.
Less than three hours later, she was back in seclusion.
A little before 9 a.m., the hospital discharged her again -- even though Ball
told JPS officials that she wanted to be in a hospital somewhere and that she
had no place to live.
To make sure she stayed away, an officer with the JPS Police Department
escorted her from the psychiatric unit and gave her a warning ticket for
criminal trespassing.
5 hospitals in 2 days
Fort Worth police gave Ball a ride to her mother's office that Friday
morning. But her mother was home in Decatur. Co-workers called her, but they
also called an ambulance.
Ball was taken to her fifth hospital in two days: Baylor All Saints Medical
Center at Fort Worth.
"I can speak all languages," Ball told the Baylor staff.
Once again, Ball refused the offered treatment and left sometime that
afternoon.
In the meantime, Jaynes was frantically trying to get her daughter committed
to a psychiatric hospital. She failed. Ball's relatives were told that all the
judges had already left for the weekend. What's more, Jaynes was told, it wasn't
obvious that Ball could hurt herself or others -- the criteria for involuntary
commitment.
At JPS, "they treated her just enough to get her stabilized a little bit.
That's what hurt us as far as getting a mental health warrant," Jaynes said.
At about 8 p.m., Ball was picked up by a MedStar ambulance at a hotel that
had complained about a psychotic woman. MedStar took Ball back to Baylor All
Saints at Fort Worth.
Within 90 minutes, Baylor called Fort Worth police to report that Ball was
threatening other patients. When an officer arrived, Ball told him that if she
was not seen by the hospital staff, she would punish him.
"I'll kick your ***, too," she said.
Fort Worth police took her into custody, transported her to JPS hospital and
filled out an application for her mental detention there.
For the third time that day, JPS ordered Ball into seclusion. A note in the
medical record explained what happened: "Patient attempted to wrestle staff to
floor. Pt. charged toward staff in search room, then sat down on floor, refusing
to dress after disrobing."
Later that night, the hospital discharged Ball again, with advice to follow
up with MHMR. Apparently, she again refused to leave.
At 1:33 a.m. Saturday, Oct. 16, almost 24 hours after she had first visited
JPS, the hospital's police force gave her another warning ticket for criminal
trespass and showed her the door.
A trip to jail
At 6:30 a.m. Saturday, an ambulance was called to a Fort Worth department
store. MedStar employees found Ball inside, next to a broken glass door. She
said she was pregnant and needed to get clothing for the baby God gave her.
MedStar took her back to JPS.
Not long after, Fort Worth and JPS police were called to the emergency room
to deal with a combative woman. JPS officer Christopher Jolly wrote that he
found a woman "that was yelling and cursing at the officer and stating, 'I'm
having God's baby and that I need to leave.' "
The officers took Ball to the psychiatric unit, this time for a voluntary
commitment, Jolly wrote. That might have saved her, her relatives believe.
But the staff turned her away, telling Jolly that she had just been released.
"The subject was then escorted off the property and advised that she was not
to return to this location unless it was for medical attention," Jolly wrote.
Ball whipped around. "I am 12 months pregnant," she said. God informed her to
have her baby sometime that night at JPS, she told them.
At that, Jolly arrested Ball, citing her with criminal trespass.
He took her to the Tarrant County Jail and filled out a referral form for
MHMR of Tarrant County, which has the mental health contract for inmates.
Hospital officials declined to comment on why Ball wasn't committed. But Witt
described the circumstances that the hospital might consider committing patients
against their will:
"The involuntary admission criteria to the inpatient psychiatric unit is
based on the determination by a physician that the patient has a valid
psychiatric diagnosis that cannot be managed in an outpatient setting and is
dangerous to self or others," she wrote.
Naked in a single cell
Ball was booked and taken before a magistrate judge, who advised her of her
rights and set bail at $2,500. Ball refused to sign the paperwork.
A second form, Request for Appointed Counsel, was also not signed. It had a
notation: "unable to understand."
At the jail, Ball went through a medical screening that JPS conducts as part
of its contract to provide medical care for inmates. Scrawled across the form's
boxes is this note: "Unable to get any answers from patient."
Ball was assigned to an individual cell in general population, with a
recommendation that MHMR follow up.
That afternoon, during the hour inmates can visit the day room, Ball came out
of her cell -- naked -- and went to the phone.
Sheriff's officers told her to put her uniform on.
She cried, "Never!"
The next day, logs show that Ball was yelling incoherently. The sheriff's
jail staff filled out another request for mental health services.
On Monday, Oct. 18, Ball's relatives -- panicked that they hadn't heard from
her in 48 hours -- tried to file a missing persons report. Fort Worth police
checked the jail logs and found her name.
Ball's sister called the jail and talked with an MHMR caseworker. She told
the caseworker that Ball had probably been off her medication for at least four
days and that her relatives wanted to help her.
The caseworker said that Ball would have to sign a signature card before
relatives could see her -- something she had so far been unable to do. But he
assured Dean that Ball would be safe, that she would see a doctor and get her
medications.
"The only reason we did not take her out is because we thought she would get
the help she needed," Jaynes said.
Later that day, jailers found Ball lying faceup on the floor with blood
coming out of her mouth, the result of a 20-second seizure.
Her last day
On Tuesday, Oct. 19, Ball was moved to the jail infirmary -- run by JPS --
for evaluation. The next day, she was sent back to her pod.
"Doesn't need medical, per Dr. Green," was a notation on her patient history.
Medical records also say that she appeared disoriented.
"Doesn't know why she is here," the history said.
Back in her pod, Ball started tearing her paper uniform and wrapping the
pieces around her neck, abdomen and ankles. Sheriff's officers called the code
for a suicide attempt and placed her on enhanced supervision.
Later that day, Ball was visited by a MHMR psychiatrist, who wrote a
prescription to address the mania. A psychiatrist saw her again Thursday, Oct.
21, after she was found with feces all over her bed.
"Staff reports that she has been refusing Psych meds," someone noted in her
chart.
The psychiatrist wrote more prescriptions for agitation and a prescription
for Haldol -- a medicine that Ball's relatives said she was allergic to.
"Though disorganized, appears less confused, improving," the MHMR doctor
noted.
Caseworkers didn't force medication on her -- they only do that in extreme
circumstances, a spokesman said.
A few hours later, Ball was found lifeless.
The what-ifs
Ball's relatives cannot help but wonder what might have happened had she
received the help she needed.
They learned from the coroner's report that she died of hypertrophic
cardiomyopathy, an inherited defect that causes thickening in the lining of the
heart. But they wondered whether her uncontrolled mania added to the stress on
her heart.
Dr. Eric Popjes, a cardiologist at Penn State Heart and Vascular Institute in
Hershey, Pa., said that stress can exacerbate symptoms of the disorder. Stress
can also cause abnormal rhythms.
But no one knows whether a link exists between manic behavior and the
likelihood of death from the condition, said Dr. Barry Maron, director of
Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute
Foundation.
"Whether that did it or not, you know, anything is possible. Is it probable?
There would be no way to know," Maron said.
Ball's relatives also wonder why MHMR didn't work to get her out of jail and
into a psychiatric facility.
But that process requires a lawyer, and Ball was never assigned one.
Sonja Gaines, chief of mental health services at MHMR of Tarrant County, said
she doesn't know what else could have been done for Ball.
"This is not to minimize her death," Gaines said. "We were dismayed with her
death. But we have psychotic people in the jail, especially with such limited
state hospital space. On any given day, you might have several psychotic people
there. She's not the sickest person we've seen."
In the end, Ball's relatives believe that her fate was sealed by JPS'
decision not to keep her in the psychiatric ward.
Ball was sick enough to deserve help, her relatives said, and she never got
it.
IN THE KNOW
ONLINE EXCLUSIVE
See for yourself some of the e-mails and other correspondence the
Star-Telegramobtained for this project.
Candid messages by doctors, nurses, JPS officials and representatives of the
Sheriff's Department are on the Star-TelegramWeb site. The complete documents
are presented so that readers can see the full context.