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March 17, 2006

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1. WHY DID NICHOLAS DIE? - South Bend Tribune, February 24, 2006

2. DOUBLE-MURDER SUSPECT INDICTED IN ASSAULT - Asbury Park Press, February 23,
2006

3. VIOLENCE AGAINST HOMELESS TARGETED - Morning Sentinel, March 10, 2006

4. MISSING SANTA MARIA WOMAN FOUND - Santa Maria Times, February 28, 2006

5. BIPOLAR DISORDER: LIFE CAN TURN TRAGIC WHEN PATIENTS DON'T TAKE THEIR
MEDICINE - The Miami Herald, March 14, 2006

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1. SOUTH BEND TRIBUNE (IN), February 24, 2006

[Editor’s Note: We previously shared another article from the excellent
investigative series “Out of Sight,” by Alicia Gallegos, which detailed how
Nicholas Rice became trapped in the criminal justice system because of actions
caused by untreated schizophrenia.

In the final installment of the series, we see how he died – died from the
intensified symptoms of his illness, a lack of treatment for them, and – perhaps
most of all – unthinking neglect.]


WHY DID NICHOLAS DIE?

By Alicia Gallegos, Tribune Staff Writer

When the first Elkhart County autopsy report surfaced months after Nicholas Rice
died, Coroner Jeff Landrum refused to sign the death certificate.

The pathologist had listed "diffuse acute pulmonary edema" as the initial cause
of death for Nicholas, an inmate found dead in his jail cell a week before
Christmas.

But the coroner had questions about the report from the beginning, he says now,
and "respectfully disagreed" with the pathologist's conclusion.

Pulmonary edema is a condition where fluid fills a person's lungs, leading to
heart failure.

Landrum, after talking with Nicholas' family and researching his background,
believed they should dig deeper.

He would also have been a fool, he admits, not to take into consideration the
private autopsy results by Dr. Werner Spitz, a Michigan forensic pathologist and
toxicology consultant who has worked on high-profile cases around the country,
such as those involving JonBenet Ramsey and Nicole Simpson.

When examining Nicholas' body, Spitz saw the young man's visibly sunken eyes and
cheeks. He noted how much weight he'd lost.

In Spitz's opinion, malnutrition and dehydration caused Nicholas' death. His
report was based on the inmate's past diagnosis of undifferentiated
schizophrenia with "untreated anorexia, refusal to eat, drink, and take
medication, severe progressive weight loss" and no evidence of disease or
injury.

Even for Spitz, the finding was rare.

"You don't usually (get) dehydrated when you are in jail," Spitz says. "You
don't usually die of the condition that Nicholas Rice did."

The famous pathologist concluded that "pulmonary edema" was the result of the
process of dying, not its cause.

***

It's hard to believe her son would starve himself to death, Diane Waldrop says.

When Nicholas was younger, he loved to devour any greasy, fatty food in sight.
He was in good health when he went to the Elkhart County Jail on the attempted
bank robbery charge, she says.

The county's second autopsy was completed in March 2005, and Nicholas' death
certificate was signed. The final findings included schizophrenia, malnutrition,
and dehydration.

Although mental illness is frequently a factor in deaths, Landrum says that in
his experience of more than 1,000 death investigations, it is rarely listed as a
direct cause. And malnutrition is certainly unusual in a 22-year-old man.

***

The words "forever in our hearts" are etched into the back of the gray stone.
The front reads:

Nicholas Dale Rice

July 17, 1982

December 18, 2004

His parents finally laid their oldest son to rest in July 2005, right before
what would have been his 23rd birthday.

The spot in Spring Run Cemetery in Stevensville is next to the grave of his
grandfather, who died during the 16 months Nicholas was in jail.

Diane hopes her father is looking after her son.

It feels like more than just a year since Nicholas has been gone, she says. He
was in jail for so long.

It's not the same seeing someone behind glass. The last time Diane hugged her
son was almost two years ago inside a Michigan psychiatric hospital.

She remembers early December 2004 and how she fixed up his old room, buying
brown curtains and throw pillows for his bed, so excited Nicholas was about to
find psychiatric help.

She thought he was strong enough to hold on, she says as the tears come.

She thought he would make it home.

***

In his one-bedroom apartment on Third Street in Goshen, manila folders are
stacked on Rick Rice's coffee table and lie in groups on his hardwood floor.
Piles of medical records, jail logs and research articles are spread around his
couch.

Some of the papers are coffee-stained, their corners dog-eared. He often turns
to one document dated Oct. 5, 2004, an emergency detention form for his son
signed by a jail psychiatrist.

It is a warning that went unheeded, Rick says, and the message continues to
plague him.

"Patient is dying from malnourishment," the form reads. "Applicant believes that
if the person named above is not restrained immediately he will die."

Nicholas was taken from the jail and treated for dehydration at a local hospital
two months before he was found dead.

Rick didn't find out about the visit until it was too late.

"There's so many things that could've been done that they didn't do," he says.
"They all dropped the ball. This was such a mess."

Rick and Diane plan legal action against Elkhart County, the sheriff's
department and the company that provides medical services to jail inmates. A
tort claim has been filed.

Elkhart County Sheriff Michael Books declined to comment about the case. But
police attorney Michael DeBoni says Nicholas did not die because of lack of
medical care by the police department.

Officers rely on the professional judgment of medical providers, he says, and
the sheriff does everything in his power to ensure inmates receive necessary
care.

***

After logging many hours at the public library, poring through research manuals
on dehydration and reading papers on mental illness during his lunch hour at the
RV plant, Rick seems to know every symptom, sign and definition.

If he had known his son was in danger, he says, he would have known to do
something to save Nicholas.

"I would've camped out on the lawn of the courthouse," he says.

The Elkhart County Jail, where his son literally starved himself to death, is
blocks away from his home. He passes the courthouse every day. Ambulance sirens
blaring down the road remind him.

But he also remembers before Nicholas was locked away, the summer barbecues the
father and son enjoyed beside the river years ago.

Nicholas always talked about being famous, moving to California to be a movie
star like his idol, George Clooney.

"I'll probably make it as an actor someday," he used to say. He wanted to be
noticed.

Maybe his son's death will bring attention to mental illness, Rick says.

Maybe Nicholas will be noticed now.

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2. ASBURY PARK PRESS (NJ), February 23, 2006

[Editor’s Note: When the media considers people with severe mental illnesses
and what can be done to help them, the most common reason is that the symptoms
of a psychiatric disorder have caused someone to harm himself or another in
dramatic, and seemingly nonsensical, fashion.

Many of the items that we feature in the E-News include or even focus on such a
tragedy. We do not select such items to highlight these tragedies, but rather in
spite of them. For instance, we present the item below not for you to consider
how Rosario Miraglia took two lives, but instead to point out the reason he did
so. He thought he would save mankind. What better evidence could there be that
the only way in which to prevent future such horrors is to bring treatment to
people lost to illnesses like schizophrenia?]


DOUBLE-MURDER SUSPECT INDICTED IN ASSAULT

By Erik Larsen, Staff Writer

FREEHOLD — A jailed man awaiting trial in the murders of his grandmother and
ex-girlfriend two years ago has been indicted, charged with aggravated assault
against a Monmouth County corrections officer.

Rosario "Russell" Miraglia, 33, of Newark was charged with swinging his fist at
a jail guard's head and neck area on Oct. 28. At the time of the assault, the
officer was investigating a report that Miraglia had contraband in his cell,
according to the Monmouth County Prosecutor's Office.

Miraglia was being held in the Monmouth County Jail in Freehold Township in lieu
of $2 million bail. As a result of this new indictment, an additional $6,000 has
been added to his bail amount, the Prosecutor's Office said.

An arraignment will be scheduled within the next 45 days before Superior Court
Judge Bette E. Urhmacher. The case is being handled by Assistant Prosecutor
Michael Costanzo.

Aggravated assault is a crime that carries a sentence of up to 18 months in
state prison.

Miraglia is charged with the murders of Julia Miraglia, 88, and Leigh Martinez,
31, on June 8, 2004, in Ocean Township. He decapitated both victims, then
severed their hands and feet, according to prosecutors, who are seeking the
death penalty in the case.

Last month, Miraglia told a judge he would present a "justifiable use of force"
defense to charges that he killed his grandmother and ex-girlfriend.

When asked why, Miraglia responded: "She cut a deal with the devil to give birth
to a dragon — something more superior to the human race. It would wipe us out. .
. . Technically, I saved mankind so it's a "justifiable use of force' defense."

Superior Court Judge Paul F. Chaiet ruled in November that while he believed
Miraglia suffered from paranoid schizophrenia, he was competent to stand trial.

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3. MORNING SENTINEL (Waterville, ME), March 10, 2006

[Editor’s Note: Below others debate whether crimes against those who are
homeless should be punished differently than criminal actions against others. We
remind you that there is another way to reduce the amount of violence against
homeless individuals. One-third of the chronic homeless have a serious mental
illness. For many of them, treatment can lead to finding or accepting housing
and a lessened vulnerability to the criminal aggression of others.]


VIOLENCE AGAINST HOMELESS TARGETED

By Susan M. Cover, Staff Writer

AUGUSTA -- Homeless advocates were cheered Thursday after a legislative
committee gave a positive vote to a bill that they hope could help reduce
violence against homeless persons.

The bill, sponsored by Rep. Patricia Blanchette, D-Bangor, makes homelessness a
factor to be considered by judges and district attorneys when determining
sentences.

It does not mandate a specific sentence if a victim is homeless. But it is
designed to raise awareness of what supporters describe as a growing trend of
violence against the homeless.

The four members of the Criminal Justice and Public Safety Committee who were
absent for Wednesday's vote on the bill registered their opinions with the
committee clerk, changing the committee recommendation from 5-4 against, to 8-5
in favor.

All four who were absent -- Rep. Kimberly Davis, R-Augusta; Sen. John Nutting,
D-Leeds; Rep. Christian Greeley, R-Levant; and Rep. Stan Gerzofsky, D-Brunswick
-- voted in favor of the bill.

Steven Huston of the Preble Street Consumer Advocacy Project said he's glad the
bill will move forward to the House and Senate with a positive recommendation.

"Even a homeless person can go to Augusta and show their cause is important," he
said. "It's a clear picture you can go and speak-up."

Those who voted against the bill said they aren't convinced that the homeless
are victimized simply because they are homeless.

They also suggested that the state should spend time and resources tackling the
problems that cause homelessness, rather than pass new laws regarding
sentencing.

Supporters, including Attorney General Steven Rowe, said it's important to make
it clear that violence against the homeless, who are particularly vulnerable, is
not acceptable in Maine. Recent videos and movies have encouraged what's known
as "bumfighting," in which teens beat-up people who are homeless.

The proposed state law now moves forward to the House of Representatives for
consideration.

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4. SANTA MARIA TIMES (CA), February 28, 2006

[Editor’s Note: An untreated mental illness can compromise a person’s ability
to perceive the reality around them. Yet symptoms can also confound with equal
devastation by inserting false perceptions into a person’s comprehension that
seem as certain – or even more certain – than what is actually happening.

A person can believe that they are a government agent, a famous author, or a
tycoon. Tiffani Burger’s symptoms endowed her with the absolute certainty that
she is married to one of America’s most successful rap stars, a man she has
never met.]


MISSING SANTA MARIA WOMAN FOUND

By Quintin Cushner / Senior Staff Writer

A Santa Maria woman who went missing six months ago has been found at a homeless
shelter in Detroit -- the hometown of the rap star she believed was her husband.

Tiffani Burger, 29, still faces the consequences of crossing state lines while
on probation. But her family is thrilled that the woman, who has battled
schizophrenia and drug addiction, is alive.

"I was just in shock," said Burger's mother, Karin Cushaway, of learning last
week that her daughter had been found. "I was just ecstatic. I started shaking."

Cushaway, of Sisquoc, reported her daughter missing Sept. 4. She has driven the
streets of Santa Maria every few days since then hoping to find her.

Santa Barbara County Sheriff's detectives investigated several reported
sightings of women who resembled Burger but all turned into dead ends. Her
information was entered into the national database of missing persons, according
to sheriff's spokesman Erik Raney.

Cushaway looks forward to reuniting with her daughter once Burger begins
treatment for schizophrenia.

"We're trying to get her the help she needs," Cushaway said, "get her on her
feet."

Burger has signed extradition papers, and is expected to be transported to Santa
Barbara County Jail in the next two weeks, Cushaway said.

Apparently, Burger's attempt to get Michigan identification papers led to her
discovery. A social worker seeking to verify her identity called the woman's
grandfather, Ron Parke of Orcutt.

Parke said the phone call came as a terrific surprise.

"Our whole family was under a lot of stress wondering what had happened," Parke
said. "We were sure she was going to contact us during the holidays because she
loved the Christmas season. But we never heard from her."

Burger's family then alerted the Santa Barbara County Sheriff's Department, who
arranged for Detroit police to take her into custody on an outstanding warrant,
Raney said.

Cushaway has not spoken with her daughter since she was found. The concerned
mother fears her daughter is angry at her for notifying police.

Cushaway had an inkling that her daughter had gone searching for the rap
musician Eminem, whose given name is Marshall Mathers, because the woman had
been obsessed with him during the past year.

"She had told me she was married to him and that they had a baby together,"
Cushaway said. "She said they had a telekinetic relationship."

However, Burger had never been east of Arizona, and Cushaway said she was
surprised that her daughter's delusions would carry her so far.

There's no indication that Burger ever knew the rapper. Cushaway said her
daughter would get belligerent if pressed on the issue.

Burger disappeared in August shortly after being released from Santa Barbara
County Jail and is believed to have been in Detroit since December. She had been
incarcerated for attacking a man with pepper spray while on probation for drugs.

Shortly before that jail stint, Burger had packed most of her possessions into
boxes and had announced to her family that her husband, Marshall Mathers, would
be picking her up soon.

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5. THE MIAMI HERALD, March 14, 2006

[Editor’s Note: This excellent profile of a mother, her two sons, and their
travails because of bipolar disorder includes insight from Treatment Advocacy
Center President Dr. E. Fuller Torrey, one of America’s leading experts on
bipolar disorder. The article also includes some excellent and realistic
information for those with a loved one who has a severe mental illness.]


BIPOLAR DISORDER: LIFE CAN TURN TRAGIC WHEN PATIENTS DON'T TAKE THEIR MEDICINE

By Desonta Holder


Despite years of therapy, despite knowing that guilt and self-blame are futile,
that what happened to one son, what still is happening to another, can only be
explained by the stark vocabulary of a medical diagnosis, Linda Pardo wrestles
always with a mother's grief, remembers with a mother's heart.

''I would lay in bed at night, and I would imagine these horrible things
happening,'' she says. ``Somebody stabbing Aaron, somebody raping Aaron. . . .
None of that happened, but he still died a worse death.''

On a summer day in 1994, Pardo's 23-year-old younger son, soaring on an arc of
manic euphoria, climbed up a pole on an Amtrak platform in Philadelphia and,
with emergency personnel hovering and news cameras whirring, inexplicably
reached out and grabbed a power line. He was badly shocked. Still, says Pardo,
''somehow he stood up and took the fireman's hand, and they helped him down and
got him on the stretcher.'' Aaron hovered at the dim edges of life for 10
agonizing days, his skin seared black, his ears burned away. At 15, he had been
diagnosed with bipolar disorder, a long-term brain illness that causes unusual,
severe shifts in mood, energy and ability to function.

The disorder, which affects more than 2 million U.S. adults, must be carefully
managed. When it is not, or when it cannot be because, as often happens,
patients do not take the medicine that helps smooth their emotional peaks and
valleys, families unravel, careers implode and life may turn violent, even
deadly.

Bipolar patient Rigoberto Alpizar had not been taking his medicine last December
when he allegedly made bomb threats aboard a plane. Federal air marshals shot
him to death on the plane at Miami International Airport. In January, another
bipolar patient, Troy Anthony Rigby, jumped from the cabin door of a plane in
Fort Lauderdale and ran toward a terminal. Authorities stopped him with a Taser
gun. He later died after a heart attack. Rigby's sister said he had not been
taking his medicine.

''It's a very sad disease,'' says Pardo, 57, an addictions counselor who lives
in Kendall. The Miami Herald has written about her before, in a 1995 story that
chronicled the impossible choices and conflicting emotions of her doomed
struggle to keep her family, and her sanity, intact, to save her children and,
finally, when she eased away from them and moved to Miami in 1993, to save
herself.

A petite woman with short, red-streaked hair who projects a compelling, often
amazing sense of calm, Pardo is a recovering alcoholic who has been dry for two
decades, and a two-time divorcée after marriages riddled with physical abuse and
emotional instability. It took her years, she says, to understand that the
definition of her life was ''trauma all the time,'' to reach ``a point where I
knew I couldn't make it better.''

Pardo's older son, Eric, now 36, was diagnosed with bipolar disorder when he was
19. He now lives in a facility in Miami. The condition often develops in the
late teens or early 20s, occurring equally in men and women. ''Many of us have
different ideas about the cause,'' says Dr. E. Fuller Torrey, a psychiatrist and
board president of the Arlington, Va.-based Treatment Advocacy Center, whose
mission is to help people get treatment. The disorder's hereditary basis --
Aaron and Eric's paternal grandmother also was affected -- ''is still very much
in dispute,'' Torrey says. But, he adds, ``None of us doubts there is a genetic
aspect.''

Diagnosis usually follows at least one episode of mania or hypomania, which is
accompanied by a range of symptoms: insomnia that lasts for several days; a
tendency to think and speak much more quickly and erratically than usual; a
spate of irrational extravagance, buying things one cannot afford or does not
need. The disorder has levels of intensity, and manic episodes may be framed by
periods of severe depression.

Aaron and Eric, with four suicide attempts each, were regarded by their
physicians as ''severely bipolar,'' an unofficial category Torrey says ``usually
means bipolar disorder with psychotic features and reasonably resistant to
treatment.''

Torrey, who has been researching the condition for 35 years, says the vast
majority of bipolar cases manage quite well: ``I know successful people who stay
on their lithium, and they're doing beautifully.''

But Pardo's sons did not stay on their medicine. Its side-effects were
unpleasant. It tamped their moods and impressions; it made their hands tremble.

''Medication compliance is a huge problem,'' Torrey says. ``Being manic can be
very pleasant. You think you're the smartest person in the world. You don't need
sleep. . . .''

At 17, Aaron enlisted in the Air Force only to receive a medical discharge six
weeks later. Shortly before his 21st birthday, he cut up all his ID cards and
left home. Police found him in Indiana three months later. As for Eric, Pardo
will never forget the day they were driving in the car, and she pulled over to
buy him ice cream. ''He takes the car and puts it in drive,'' she says, ''and
he's laughing . . . , and he slammed into [another] car that was parked there,
still laughing.'' At home, the young men would chain-smoke and gulp down cups
and cups of coffee, cans and more cans of soda.

''They always felt like hell, so why not?'' Pardo says.

She suffered for them and for herself. She came down with severe headaches; she
tried to ignore the weakness gnawing at her legs. So many bad things happened,
in fact, that she no longer can accurately chart their chronology. ''I remember
times being horrific, but I couldn't tell you what happened in what
succession,'' she says.

And what was she to do about protecting the boys' sister, her youngest child,
her Lola, now 27? How to keep things as normal as possible for her? ''I went to
every PTA meeting,'' Pardo says. ''I even had her in gymnastics.'' Pardo refused
to accept that ``I was the mother who couldn't fix it. When you're a counselor,
and when it's your own blood, it's two different ball games.''

So she tried and tried. She hoped and hoped that things would get better. They
did not.

One day, around 1990, Eric phoned her from a motel to say he had overdosed on
his mood stabilizing medication. Pardo called for emergency help and then
'started screaming, `Hang on, Linda! Hang on, Linda!' . . . I felt my whole self
disconnect. . . . The next day I was completely curling in a ball, screaming.
'Make me safe! Make me safe!' Couldn't stop sobbing. Went to the mirror, thought
it was two-way, started ducking. I knew I was in a psychotic state. . . . My
mind said, 'You had a breakdown.' '' It was six months before Pardo would rouse
herself enough to put on lipstick.

It took her even longer to rouse herself enough to leave, to realize that she
could not determine what happened to her sons, to settle them into an apartment
and head for the sprawling anonymity of South Dade. Within months, Aaron had
burned the apartment down. Then he burned up maybe the only thing he had left:
himself. ''It never mattered how much you did or how much you tried,'' Pardo
says.

After Aaron's death, Pardo returned to Miami, again alone.

Emotionally destroyed by the way her brother had died, Lola stayed behind with
her father. Eric was living in a facility in Philadelphia.

''I couldn't bring Eric down,'' Pardo says. ``I was in survival mode. . . .
Everybody was in such pain.''

The pain had not eased much two years later when Pardo checked Eric into a
facility in Boca Raton. ''I really knew it was not a good idea, nor was I
ready,'' she says. Eric was not ready either. He ''really never took to the
therapy, was very defiant.'' Then he ran away. The police found him in
Jacksonville. Pardo returned him to Philadelphia, sending him money and keeping
in touch by phone.

''It was so painful to listen to him,'' she says ' . . . And he was always
freezing. . . . I sent him a beautiful suede coat one time. Two days later he
said, `I don't want you to get mad. It was stolen.' ''

In the fall of 2004, after Eric almost burned down the Philadelphia facility in
which he was staying, his mother bought him a ticket to Miami and found a place
that he would accept.

''To have him live with me, . . . it wouldn't work because it would end up being
a yelling match over things he would want and I would want,'' she says. ''He's
6-foot-3, about 275 pounds.'' In October, Pardo went back to Philadelphia to
visit Lola, who is working through her pain.
Pardo sees Eric every two or three weeks. They go out shopping and to the
movies. For Christmas, she bought him a TV, a DVD player, movies and curtains
for his room.

''It feels so much better having him here. He'll stand like this'' -- legs
spread, leaning from side to side -- ''and do like this dance, going back and
forth from one leg to the other,'' she says. She pays for his dental care, and
''I give him $30, $40. Of course, it's gone in 10 minutes, but I feel like I'm
trying.'' They call each other often, spending a lot of time on the phone. For
years, after phone calls Pardo would hang up and sob for hours.

She doesn't do that anymore. ``Now I just pray.''

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EPISODES, TREATMENT, CAREGIVER TIPS

SYMPTOMS: Dr. Jorge I. Casariego, head of Mercy Hospital's department of
psychiatry, says these include extreme energy, sleeping very little,
overspending, extreme sexual promiscuity and severe episodes of depression. The
manic phase can occur much later than the depression phase, fooling a lot of
people. ''People sometimes drink a lot to sedate themselves when they're
manic.'' The younger the patient, the more severe the disorder.

CYCLES: The mania and depression cycles are unpredictable. Some can last for
weeks; others for months. ''There's no limit, no minimum to cycles,'' Casariego
says, which often occur every year or every two years. ``But some people are
rapid cyclers with multiple cycles a year.''

TREATMENT: The patient must maintain adequate treatment. ''Lithium is extremely
effective in controlling moods,'' Casariego says, and the patient should have
his blood tested often in case the doctor needs to adjust his dose. (More
information about lithium, page 12) ''Lamictal is wonderful, effective in
controlling the cycles, particularly depression.'' Psychotherapy helps with
stress, which may trigger cycles. Before modern drugs and therapy, Casariego
says, stress was so severe that patients died of the sheer exhaustion of being
stressed.

CAREGIVERS: ''You have to use good judgment,'' Casariego says. If a patient
refuses to take medication, ''don't provoke them, because rage is a major
problem.'' Stay calm, and try to get them into treatment. If there is immediate
danger, call 911; specify you are trying to have a patient admitted to care
under the Baker Act. If the patient is behaving bizarrely but seems not to be in
immediate danger, ask a judge for an ex parte order, for hospital admission for
evaluation.

RESOURCES: The University of Miami Psychological Services Center, 5665 Ponce de
Leon Blvd., Coral Gables, holds a monthly Bipolar Family Workshop

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