from THE NEW YORK TIMES, October xx, 1996, pp, B1, B4
permission for reprint granted on Dec. xx, 1996 by the New York Times as per

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Committed Against His Will
For Medical Student, a 5-Week Psychiatric Ordeal


By ELISABETH ROSENTHAL



In July, Leonard Drey got high marks as a senior medical student at Coney Island Hospital, treating patients with heart disease and AIDS.

In early September, he was back at Coney Island, this time locked in a psychiatric ward, after psychiatrists from his medical school declared him dangerous and had him committed.

Mr. Drey, who suffers from manic depressive illness, spent five weeks in the hospital against his will, despite protests from his lawyers and psychiatrists that he had harmed no one and did not meet the legal standard for commitment. Wearing shoes whose laces had been confiscated, he passed endless dull days watching television, reading old medical texts and working the pay phone, calling doctors, lawyers, friends, reporters, anyone who might help him get out.

While state law guarantees patients hospitalized involuntarily an expedited hearing, Mr. Drey's court date was delayed for more than a month, first because of scheduling problems and then because the lawyer for the hospital was ill.

Last week, bowing to the opinion of four psychiatrists, a Brooklyn judge ordered him released. Mr. Drey was left with a $39,000 hospital bill. His ordeal left questions about whether the commitment was justified and whether the legal system to safeguard the rights of such patients is adequate.

In commitment papers and medical records, doctors from the State University Health Science center at Brooklyn, where Mr. Drey was a student, and at Coney Island Hospital contended that he was "guarded, hostile and uncooperative" and accused him of threatening, erratic and possibIy delusional behavior. But to support their contention that he possessed "a real and present threat of substantial harm to himself or others," the legal standard required for commitment, they rely mostly on one example: a minor altercation with a fellow medical student that involved name-calling and possibly a push.

While Mr. Drey acknowledged that he was exhibiting some symptoms of his manic depression last month, he insisted that he posed no danger to anyone when medical school officials led him from an infectious disease course and forced him to undergo a psychiatric evaluation.

"There was no medical or legal reason for hospitalizing me," he said. "If they had a problem with my behavior, they should have called me to discuss their concerns and then , maybe, suspended me with instructions to see my psychiatrist before coming back."

The law grants any doctor broad power to order dangerous patients with mental illness committed after a brief examination, to protect society and patients themselves from harm. That power, however, is supposed to be balanced by legal safeguards to prevent mistakes and abuse. But Mr. Drey's case illustrates the potential pitfalls in this balancing act. While a patient can be committed quickly, reversing the process can be far more difficult. Hearings can be delayed for weeks, and the outcome often depends as much on where the case is heard as on the patient's mental condition. And while Mr. Drey, the 37-year-old son of a prominent Midwestern family, had the knowledge and money to hire psychiatrists to win his release, many patients have no such support.

"He lost five weeks of his life and maybe his medical degree," said Michael Lander, a legal scholar with a history of schizophrenia. "What happens to someone who can't marshal those resources? Many commitment hearings are an outrage."

The Commitment

A History of Confrontations


Mr. Drey was diagnosed with mental illness 17 years ago and has been hospitalized six times before, twice involuntarily. Despite this, he has two degrees and has worked as a journalist and scientific researcher. He usually received good grades in medical school, but acknowledged that he had several run-ins with the administration, and just before his commitment, had threatened the dean with a lawsuit over a course grade.

Friends and colleagues described him as thoughtful and extremely bright, if headstrong, and said he often chafed at the boot-camp mentality of medical school. "He kept challenging superiors, which is counterproductive here," said Daniel Soutern, a fellow student and friend. "I counseled him to toe the line."

The path this led to hospitalization began in the early summer when, with the consent of his psychiatrists, Mr. Drey tapered off his psychiatric medicines because they made him feel dull and to see how he would be without them.

In July, he spent a month working at Coney Island Hospital, where he earned high praise. "He was excellent with patients and with colleagues," said a doctor who supervised him, speaking on condition of anonymity.

Dr. John Knesevich, a psychiatrist who had treated Mr. Drey when both lived in St. Louis, saw him at the end of August and felt he was basically well. "It didn't even cross my mind that he needed hospitalization, involuntary or otherwise", he said. "I didn't even think he needed medicine."

Dr. Knesevich did say, however, that he was concerned because his patient seemed "mildly euphoric" which he took as a warning that his manic depression might he reemerging. During the next 10 days, Mr. Drey said, he became more "high" and confrontational. He was' thrown out of a restaurant for pestering the chef and another for arguing with a waiter, and had two arguments with police officers, incidents that were out of character, friends said.

"Leonard was definitely racing, but he was also coherent and he knew at some level he had to stop this process,", said a friend who insisted on anonymity. "It would have been nice if there was a better mechanism than confronting him and throwing him in the hospital.

Then came the argument with another student. They traded insults and she complained to school administrators about Mr. Drey. School officials and he had pushed her, though he denies it.
(The student, Sarah Egan, referred all question to the medical school. Officials at the medical school as well as Coney Island Hospital defended their treatment but 'refused to comment on the case, citing confidentiality rules.)

On Sept. 10, four days later, Mr. Drey was asked to go to a dean's office, where school administrators and a psychiatrist were waiting. After a 20- minute evaluation, he was escorted by two security guards to Kings County Hospital, an affiliate of the medical school. He was transferred to Coney
Island, another public hospital, the next day.

The commitment papers and admission notes asserted that Mr. Drey was dangerous, but shed little light on how the doctors came to that conclusion, other than referring to the "alleged" assault which is never described in detail.

Most commitment proceedings involve serious acts of violence or severely distorted thinking; for instance trying to throw a child out a window in the belief that he is possessed by the Devil.

"This case falls far short of the commitment standard," said Dennis Feld, a principal lawyer for Mental Hygiene Legal Services. "The lesson here is if you have a history of mental illness, never raise your voice and never push someone."

While Mr. Drey's own psychiatrists were reluctant to pass judgment on the initial commitment, since they did not see him at the time, Dr. Lawson Siegel, an independent court-appointed psychiatrist, noted that the pushing incident had never been confirmed and that the victim was apparently not injured. "This would tend to argue that even when he was most ill, he was not a continuing danger," Dr. Siegel said.

Mr. Drey's lawyers also criticized the medical school for using its own doctors to evaluate him, rather than seeking an independent judgment, and questioned whether the school was in part motivated by desire to get rid of a troublesome student.

If Mr. Drey had worked in a law firm or a restaurant, they said, he would more likely have been dismissed or told to stay away from work until he sought treatment.

Kris Glen, the dean of the City University of New York Law School, said the case might reflect a common tension in commitment.

"The doctors may be well-meaning," she said. "They think here's this student who is very smart and sick, and we'll just commit him and he'll get better and come back to school. But the law imposes a different burden."

The Release

Odds Are Against Getting Out


Mr. Drey filed for a court hearing to gain his release at 11:15 A.M. on Wednesday, Sept. 11, 15 minutes after he got official notice that he was being held.

The odds were against his success. While many counties rotate judges for commitment hearings, a vast majority of such cases in Brooklyn are heard by one judge, Maxine Duberstein, who rarely forces hospitals to let patients go. Statewide, judges release 30 percent of patients at hearings, while in Brooklyn, the figure is just 2 percent, according to Mental Hygiene Legal Services.

Moreover, the only person who usually testifies at such a hearing is the psychiatrist who is holding the patient involuntarily.

"Statutes guarantee all sorts of legal protection, but in practice it doesn't always happen," said Michael Perlin, a professor at New York Law School. "And society winks at that, because we say that treatment is in the best interest of the patient." He added that highly publicized cases of mentally ill patients who commit violent acts have made judges extremely cautious.

For most of September, Mr. Drey was stuck in the dreary routine of his fifth-floor hospital ward. It is a regimented place, with 6:30 blood pressure measurements as wake-up calls, where meals are the high point of the day and the principal activity is watching television, with men and women in separate lounges. Injections and the threat of straitjackets (referred to as "camisoles") are meted out to those who act up.

Mr. Drey's case did not even make it onto the court calendar for almost two weeks. Commitment hearings for patients at Coney Island Hospital are held only on Tuesdays, and the next Tuesday was full. That first date, Sept. 24, was postponed to Oct. 1, so that a psychiatrist whom Mr. Drey had hired could complete her evaluation.

By mid-September, Mr. Drey had been put back on his medications.  By late September, Dr. Ruth Finch, the psychiatrist Mr. Drey hired to testify, was prepared to say he did not need hospitalization. But Mr. Drey was angry and uncooperative with the doctors at Coney Island, refusing even to let them get in touch with his psychiatrist. They continued to insist he was seriously ill.

At 9:30 A.M. on Oct. 1, Mr. Drey was bused under guard to State Supreme Court in Brooklyn. Two hours later he was bused right back. Justice Duberstein postponed the case for a week because Michael Forth, the lawyer for Coney Island hospital, was ill and did not show up.

On Oct. 8, Mr. Drey was again bused to the courthouse. By this time, three widely respected psychiatrists had said that he did not belong in a hospital, including his psychiatrist for the past three years, Dr. Jonathan W. Stewart, whose report said that Mr. Drey had no history of violence and was conscientious about taking medicines and keeping appointments. But Mr. Drey again left without a hearing.  The judge had decided that an independent psychiatrist should evaluate the case.

Mr. Forth, the lawyer for the hospital, said Mr. Drey bore part of the blame for h is long hospital stay, since he refused to provide doctors with information that might have led them to discharge him earlier. And Judge Duberstein said, "It looks like a tremendous number of days, but it's not when you consider the court schedule and all those doctors examining him."

On Oct. 15, Dr. Siegel, the court-appointed psychiatrist, submitted a 15-page report recommending release. Judge Duberstein agreed, though she added that she thought Mr. Drey had been held with good reason. "You're going to get a break on this," she said.

It did not feel like a break to Mr. Drey, who had missed five weeks of his life and would have to apply to re-enter medical school, where his future is uncertain. He headed out of the courthouse into a crisp fall day, an endocrinology text in his hand. he walked across Adams Street to buy shoelaces.