Mental health treatment in Kansas facing new scrutiny after apparent homicide

An alleged homicide at a Kansas assisted living facility may bring new scrutiny to the state’s treatment of its mentally ill residents — and whether the state spends enough to protect patients and the public.

Brandon Brown, 30, of Haviland, Kan., now sits in the state hospital in Larned. He’s been charged with second-degree murder in the death of 61-year-old Jerry Martinez after an altercation at the Haviland Care Center in Kiowa County, a residential facility west of Wichita, where both men lived.

The fatal fight came just three days after Brown was released from the state-run psychiatric hospital in Osawatomie, Kan. He was sent there after scuffles with two residents.

Brown’s father, James Brown, believes state budget problems prompted Osawatomie to release his son too quickly.

Critics have said the facility is understaffed and underfunded. Brandon Brown’s weeklong treatment came just a few months after the state began an “aggressive triage” policy designed to address overcrowding at Osawatomie.

Privacy laws keep some records of Brown’s time in Osawatomie closed from public view. State officials will not say if he was a patient, and declined several requests for comment on the case.

But Haviland Care Center administrator Ron Friess confirmed Brown’s time at Osawatomie. Also, discharge records obtained by The Star show Brown was admitted to the acute care psychiatric hospital on May 7.

The papers show Brown was sent to Osawatomie after fighting with two residents at Haviland. “He is reported to have become aggressive, suspicious, belligerent and assaultive,” the document says.

Brown made “good progress and was compliant with his medications” during his time at the hospital in Osawatomie, the discharge report notes, although the prognosis was recorded as “guarded.” He was released May 14, to the care of the Haviland facility.

On May 17, Brown fought and injured Martinez, according to a report from the Kiowa County sheriff. After an alleged scuffle with law enforcement officers, Brown was taken into custody and charged with aggravated battery.

Martinez died in early June. The charges against Brown were upgraded to second-degree murder.

Some advocates for the mentally ill said there is no way to determine from the public record if staff and budget challenges were a factor in Brown’s release from Osawatomie and return to Haviland. It’s possible Brown showed no signs of potentially aggressive behavior and was released for that reason, they said.

The discharge report says Brown was “advised to stay on the med and not to use alcohol or street drugs,” but it contains no specific medical or psychiatric recommendations.

But James Brown now thinks state budget constraints played a role in what he believes was his son’s premature return from Osawatomie and the subsequent homicide.

“Just look at how short-staffed they are,” he said. “Those nurses are working 16-, 18-hour shifts.”

In May, The Topeka Capital Journal said nearly 40 percent of the positions at the Osawatomie hospital were recently vacant. Additionally, the facility is undergoing a $3 million renovation and may lack space. It recently froze admissions, a move locally based mental health officials think may cause a backup of patients needing intensive treatment.

Last year, the federal government threatened to withhold Medicare reimbursements to the facility if overcrowding problems remained unaddressed.

Rebecca Proctor, executive director of the Kansas Organization of State Employees, said Osawatomie staff members are overworked and underpaid.

“It endangers both the patients and the staff,” she said. “When you’ve been on duty that long — I don’t care how conscientious you are — you’re tired. And your mind isn’t as sharp.”

Angela de Rocha, a spokeswoman for the Kansas Department for Aging and Disability Services, said she could not comment on the apparent homicide. But in an email she said, “The discharge planning processes at both Osawatomie and Larned State Hospital are rigorous and designed to ensure that individuals who are discharged leave the hospital with appropriate supports.”

She would not say if the decisions in the Brown case are under review by the hospital, or by the agency.

Rick Cagan, executive director of the Kansas chapter of the National Alliance on Mental Illness, declined to comment on the specifics of the case. But he said the Kansas mental health framework faces budget and staffing pressure at all treatment levels, from state-run hospitals to community health centers.

“The state system is under stress,” he said.

In a position paper, the Kansas Mental Health Coalition wrote: “The state’s psychiatric inpatient system is at the breaking point. Simply put, it does not have the capacity to meet the demand placed on it to serve the large numbers of Kansans who experience mental health crises every day.”

Some of the reductions in state mental health spending in Kansas came under Democrats. But the fallout from the Brown incident may affect current budget choices in Kansas.

Earlier this month, Gov. Sam Brownback’s office threatened to cut funding for the state’s mental health facilities, including Osawatomie, to convince lawmakers to raise taxes. Legislators eventually passed the largest tax increase in state history.

But the governor must still find almost $50 million in state spending cuts to balance the state’s books. That could include mental health cuts.

A spokeswoman for Brownback declined comment on the Brown case.

The state’s approach to treating mental illness has been under the microscope for years. It involves public and private treatment and counseling facilities, as well as the state psychiatric hospitals in Osawatomie and Larned.

Last summer, Osawatomie was 25 percent above its capacity of roughly 200 patients. This year — responding to criticism from the federal government — the hospital began the $3 million renovation project and restricted occupancy of nearly a third of its available beds.

Those restrictions were not in place in early May, de Rocha said. That’s when Brandon Brown was a patient there.

In a recent news conference, Brownback said he wanted to take another look at the state’s treatment programs for the mentally ill. He said the state may want to examine programs to intervene more quickly at the local level, reducing the cost pressures at the state’s facilities.

Brown’s criminal case has been transferred to the Kansas attorney general’s office at the request of the Kiowa County attorney.

The Star filed an open-records request with that office, seeking details of the incident and the arrest. The office provided some related documents, but withheld others citing state law.

Kansas law generally considers mental health commitment cases to be private. The Kiowa County District Court Clerk said no public documents are available concerning Brown’s arrest and commitment to Larned following the altercation.

Workers and residents at the Haviland facility are still coping with the incident.

“It was devastating,” Friess said.

James Brown says his son has undergone treatment at different facilities for years. Kansas, he said, does not treat mental illness effectively.

“I’m going to fight the rest of my life,” he said, “to make sure this doesn’t happen to someone else.”

This story was originally published June 27, 2015 at 11:37 PM with the headline "Mental health treatment in Kansas facing new scrutiny after apparent homicide."