Family Left In The Dark On Suicide Of Teenager — (The New Jersey Record)

SSRI Ed note: Teen given Paxil, then Zoloft becomes argumentative, suicidal, dies by suicide by hanging himself, in hospital.

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The New Jersey Record

April 9, 1995

Author: By DEBRA LYNN VIAL, Staff Writer; The Record

Sitting alone in his tiny bedroom, 14-year-old Nicholas Falasca spent hours writing on his computer about his loneliness and pain.  “My life is nothing. It will never be anything.”

“I feel like I’m dead.” “Help me.”

His mother reads these notes several times a day. She is somehow comforted by the grim words.  “It’s all we have left of him,” Mary Falasca said.

A month after the Bogota High School freshman hanged himself with a sheet in a children’s psychiatric unit of Bergen Pines County Hospital, where he had been admitted following a failed suicide attempt, his family is still waiting for answers about his death.   Most of their questions have been met with silence: How did Nicholas, who had attempted suicide three times, hang himself in a room designed to prevent suicides?

How could he have rigged a noose if, as hospital officials say, he was out of sight for only three to five minutes? Who took their son off suicide watch? Three hours before his death, Nick was laughing with his family, and his doctors said he could return home soon. What went wrong?

Most important, the Falascas say, Bergen Pines officials still haven’t told them anything that helps to understand how the child they entrusted to the care of trained professionals could be dead by his own hand six days later.  “We put him in Bergen Pines because he was supposed to be safe there,” Falasca said. “We knew he wasn’t safe at home, so we took him to people who could help. Now he’s dead, and nobody’s talking. It’s a nightmare.”

The only thing the Falascas know for certain is what a nurse told them over the phone the night of March 12: Nick had killed himself and was found dead on the floor near his bathroom at 6:15 p.m., with a white sheet around his neck. The autopsy confirmed that he died of asphyxiation, evidently self-inflicted.

Bergen Pines has given the Falascas a portion of their son’s medical records, but it reveals little about his death.   “Something went terribly wrong here,” said the Falascas’ attorney, Robert Chester, who also has been unable to get many answers from Pines officials.   Bergen Pines officials declined to answer a reporter’s questions about what the Falascas have been told. A senior Pines administrator would say privately only that the family’s questions would be better directed to the Bergen County police and the state Health Department; both are investigating.

Bergen County police Lt. James Spar said the family can have a copy of the police report only after the investigation is complete and only if they obtain a subpoena. Spar said police want to control who gets information about what he called a “sensitive case.”  State Health Department officials declined to comment. As did their counterparts at Bergen Pines, they cited confidentiality rules barring disclosures about psychiatric patients, even when the patient is dead.

“They’re hiding from us,” said Falasca, a 39-year-old waitress.    The Falascas are considering suing Bergen Pines, but that is unlikely to yield more answers. State law severely limits suits against public mental-health institutions, such as Bergen Pines, and their employees.   “I don’t want money. I want answers,” Falasca said. “We need to know what happened so we can prevent someone else from losing their child.”

Nick was her only son, the youngest of three children. He had always been smaller than his classmates, always timid, insecure, and awkward, she said.  “He was the one kids picked on,” said Janie Mancino, a classmate.”You felt sorry for him when you saw him all alone in the lunch room.”   Falasca can’t stop thinking about what her troubled son whose delicate good looks and perfect smile had earned him modeling spots on national commercials was thinking during the final moments of his life.

“I wonder if, at the last second, he thought: `Somebody help me. I want to live,'”  she said. “And nobody was there for him. Nobody was there.”

Nick’s records show that an unidentified member of the team of Bergen Pines staff psychiatrists had taken him off suicide watch. Regulations allow hospitals to set their own policies on monitoring patients. Bergen Pines officials declined to say how often they check patients.

It could be several months before the Health Department issues a report about whether the hospital erred in any way, said Catherine G. Morris, director of health facilities inspection services. A local mental health official said a preliminary investigation shows that the hospital followed proper procedures.

State officials say Nick’s death was the first suicide in the psychiatric ward of the 1,200-bed hospital in at least five years. The 214-bed ward has received favorable reports in recent inspections.   Mental-health experts say the suicide is a painful reminder that, regardless of precautions, someone intent on killing himself will succeed.  The files left in Nick’s computer offer insight into a troubled life: Feelings of boredom and betrayal by friends, pleas to “Put the feeling of life back into me,” and prayers for God to “Pull me up to your place.” Nick spent hours gazing out onto Route 80, watching the cars and wondering where people were going. “I wish I was one of them so I know how it is to have a life.”

In all, Nick attempted suicide three times: once with sleeping pills and twice by cutting his wrists with a razor, neither time causing wounds requiring stitches. He had been seeing a counselor for a year.    Nick’s teachers remember him as a student “who always had a smile on his face.” The same teenager who wrote poems about being friendless was elected treasurer of his class. And dozens of his classmates were so upset about his suicide that they met with school grief counselors.

Nick lived the busy life of the normal suburban teen, and then some: He was on the wrestling team, had a part in an upcoming school play, and played the trumpet in the school band.  His modeling career included commercials for cereal and eyeglasses; on the day he died, his photo appeared in a national advertisement for a discount chain.

Nick’s parents were surprised when he and a friend were arrested in early March after being found on the roof of a neighbor’s house. Police  put the teens in jail to scare them, Falasca said. That night Nick cut his wrists the second time. ” He told us he didn’t want to live anymore,” she said. “His father and I couldn’t believe it.”They decided he would be safer at Bergen Pines. Nick wanted to go.”I’m glad I’m here,” he said told a psychiatrist who diagnosed him as severely depressed. “I’ve been sad a long time.”

While on suicide watch for the first four days, his mood changed by the hour: Sometimes he was angry he wasn’t dead. Other times, he wanted to “be happier,” the medical records obtained by the Falascas show.   Nick didn’t know why he had been depressed for so long. Like many teens, he felt pressure at school. He hated quarrels at home. He worried that his classmates would discover he was in a psychiatric ward.

After a few days, Nick no longer wanted to hurt himself. But he began to act up: He fought with patients and touched a female patient’s stomach. He threw food in the cafeteria and laughed during serious conversations in group therapy. And he complained of dizziness, the records show.

On the afternoon he died, Nick seemed happier than he had been in a long time, Falasca said. He hugged his family and said, “I’ll see you soon.” He had been planning a trip with his sister to Delaware later in the week.  His records don’t indicate what went wrong.    t 2:30 he was “enjoying attention” from his family. The next entry is at 7:15. In shaky handwriting, it says Nicholas was found on the floor an hour earlier, a sheet wrapped around his neck. Doctors attempted to resuscitate him for an hour. t 2:30 he was “enjoying attention” from his family. The next entry is at 7:15. In shaky handwriting, it says Nicholas was found on the floor an hour earlier, a sheet wrapped around his neck. Doctors attempted to resuscitate him for an hour.

How Nick killed himself is unclear. A hospital official who declined to be identified said Nick ate dinner, returned to his room, and hanged himself by rigging the sheet to the door.  Chester, the family’s lawyer, was told unofficially that the teen used a hook in the bathroom which, according to regulations, should have broken under his weight.   When Falasca got to the hospital, she was kept from seeing her son’s body for an hour, she said.

Falasca found her son’s carefully typed notes and poems just a few days after his death. She has read them so many times, the printouts are crumpled.    “I’ll have them memorized soon,” she said. “I miss him so much. He was so needy. He needed to be protected.”

Law largely on Bergen Pines’ side

State law largely protects Bergen Pines County Hospital from a civil lawsuit in the suicide of a 14-year-old Bogota High School freshman who hanged himself with a sheet.   The statute severely limits lawsuits against all public mental-health institutions, such as Bergen Pines, and their employees in cases involving the “terms and conditions of confinement” of psychiatric patients a phrase that incorporates treatment and supervision issues.

As part of the state Tort Claims Act or sovereign immunity laws the statute protects taxpayers by shielding government agencies from huge liability awards. Mental-health facilities are protected specifically in cases involving treatment, use of restraints, and patients injuring other patients.    “Getting past this law is a hard sell,” said Ernest Villa Jr., a Hackensack attorney who deals with mental-health issues.

Successful suits have involved blatant neglect or malpractice on the part of an employee who is affiliated with, but not solely working for, the hospital.   In 1987, a psychiatric patient who suffered severe brain damage in a suicide attempt at Bergen Pines won a $1.8 million judgment against the hospital and four employees who failed to follow orders to check on him every 15 minutes.

The patient had been strapped to a bed but managed to free himself. He set the bed on end and hanged himself by his leather restraints.   “There are ways around the law, but it’s not easy,” said E. Carter Corriston Sr., whose Hackensack firm represented that man’s family.   Mental-health advocates call the law appalling.

“Patients and their families want the right to sue because that is their way to force change,” said Ruth Pratt, a Bergen County attorney who represents psychiatric patients. “It’s their way to make sure a facility is doing its job. Public hospitals say we’re just supposed to trust them. That’s not good enough.”   Bergen Pines used the statute to defend itself successfully against a suit in 1983, after a patient who had been taken off suicide watch escaped and was struck by a car. In 1989, the courts dismissed a similar suit against a South Jersey facility in which man taken off suicide watch doused himself with gasoline and died after setting himself on fire.    Similar incidents have cost private hospitals millions, attorneys said.

“Private hospitals would end up paying because a doctor didn’t notice a warning sign of suicide,” said Carl Nieman, a Newark malpractice attorney.

Robert Chester, the attorney for the family of 14-year-old Nicholas Falasca, has called for toxicology tests to determine whether Nicholas’ antidepression medication first Paxil, then Zoloft could have caused his suicide.  In the days before he died, Nicholas complained of dizziness and began to argue with other patients.

“We think he was acting out because of the medicine, and they should have recognized that something was wrong,” Chester said.   Meanwhile, the Falascas may complain to the state Board of Medical Examiners about the Pines’ staff psychiatrist, as yet unknown to them, who took their son off suicide watch.   But even that will be difficult: The standard practice of treating psychiatric patients is to give them more freedom as they progress.

“The problem is that you don’t always know what is going on in a patient’s mind,” said Dr. Greg Sternan, an Englewood psychiatrist.

Record Number:  1962021