Judgment Call

A joint state and federal investigation has concluded that emergency room personnel at Fairview Southdale Hospital acted "appropriately" in December when they decided not to place a 23-year-old Eagan man on a psychiatric hold or to transport him by ambulance to another facility for further evaluation. Shortly after leaving the hospital Stephen Miles decapitated his stepmother, according to Dakota County prosecutors.

But critics assert the report—based on information collected by a state official and reviewed by a private agency under federal contract—raises as many questions as it answers: The ER visit was reported not to have been Miles's first trip to a hospital that day; and the psychologist contacted by the ER doctor thought that Miles "definitely seemed to be psychotic" and probably would be held. Meanwhile, a state lawmaker who in 2001 shepherded a change in the law making it easier for hospitals to hold mentally ill patients in crisis says she's concerned that the new law wasn't followed in the case.

When Stephen Miles arrived at Fairview Southdale the evening of December 30, 2005, he was carrying the film from an MRI he'd had two weeks earlier and complaining that his head was changing shape. The doctor asked to examine Miles physically. Miles refused, saying he just wanted his film read; he was concerned microwaves might be causing growths on his head, or that he had a bone disorder.

Miles's father Roland then explained that the young man had a history of psychosis, had announced earlier in the day that he was going to remove his own filling with a bent fork because it was absorbing microwaves, and had briefly strangled Roland Miles when the father had tried to stop him. Stephen Miles listened briefly, and then walked out of the exam room. Roland Miles told the doctor that the two had already been to Fairview Riverside, where a doctor pronounced the MRI film normal. He was concerned that his son's psychosis was escalating and he was afraid. He asked if police could strap Miles to a gurney.

After some discussion, during which Roland Miles repeatedly expressed his concern, the doctor suggested that Stephen Miles be evaluated at the behavioral emergency center at Fairview Riverside, according to the investigation. While Roland Miles went outside to talk to his son about the plan, the doctor called a psychologist at Riverside. The doctor said that he did not think he could have Miles brought back inside by security because he didn't meet the criteria for an involuntary hold. The physician asked Roland Miles if he felt comfortable driving his son to Riverside; according to the doctor, Miles said yes.

The Riverside psychologist who spoke to the physician, meanwhile, said that "he thought the patient would be held based on the fact that the 'patient definitely seemed to be psychotic' and would not be discharged if he were showing strong signs of psychosis," according to the report. The psychologist noted several signs of psychosis, including Miles's delusions about his head, his paranoia, and his refusal to let the doctor touch him. The psychologist "thought that the patient was coming over by ambulance, however he did not recall physician telling him how the patient was going to get to [Riverside]. He did not recall if he told physician to place patient #1 on a hold." About an hour later, Riverside got a call saying the Mileses would not be coming.

After being turned away from an emergency room in Anoka County in 2000 in the midst of a mental health crisis, Larry Dame killed his sister, her husband, and their three children. In 2001, state Rep. Mindy Greiling (DFL-Roseville) authored legislation making it easier in Minnesota to hold people like Dame. Doctors no longer have to judge harm to be "imminent," she says, and patients can be held if it is more probable than not that they're going to suffer psychological deterioration.

"I have always thought we needed a lawsuit to get them to comply with the new law," says Greiling. "I know the family has an attorney, so I'm hoping that attorney will study the law and proceed."

Fairview faxed a statement to City Pages that reads in part, "when situations like this occur, everyone involved is devastated," before concluding: "We have reviewed the investigative report and agree with its findings."

Minneapolis attorney Terry Wade handled the Dame family's lawsuit against the hospital that would not admit Larry Dame in 2000. "I'm a little surprised by the conclusion," says Wade. "It strikes me that the psychologist pretty much told the ER doctor that a hold would be effected." By his read, the report represents the conclusion of just one person.

Last week a Dakota County court found Miles too mentally ill to assist in his defense. He will be committed to a state psychiatric hospital and evaluated periodically. If he is eventually able to stand trial, a separate process will gauge whether he was legally sane at the time of the killing.