A Wrongful Death: One Child's Fatal Encounter with Public Health and Private Greed. - book reviews

Washington Monthly, Oct, 1997 by Charles Slack

In March 1992, four month into her stay at Southwood Psychiatric Center in San Diego 13-year-old Christy Scheck tied sash of her terry cloth bathrobe around her neck and, while sucking on a Tootsie Pop, hung herself against her bathroom door.

Southwood, to which Christy's parents entrusted their daughter on the advice of a psychiatrist, proved to be a sort of malevolent Wonderland, full of criminally greedy administrators and inexperienced counselors whose ineptitude might have seemed comical had not the stakes for the Scheck family been so high -- and the outcome so tragic.

Journalist Leon Bing's book, A Wrongful Death: One Child's Encounter With Public Health and Private Greed, unsparingly recounts Southwood's deplorable handling of Christy Scheck's case and raises broader questions about the way mental illness is treated (or, too often, mistreated) in the United States. Southwood's parent company, National Medical Enterprises (NME), ran 76 hospitals around the country, and the problems were by no means limited to one hospital.

"Put heads in beds" was the charming directive from Southwood management to staff Parents who phoned advertised hotlines for advice on Susie's temper tantrums or Bobby's sullen moods were inevitably urged (assuming die family was well-insured) to bring the child in for an evaluation. Uninsured families were sloughed off on publicly funded programs or free clinics. The subjective nature of diagnosing mental illness -- as opposed to the cold reality of, say, a fractured fibula -- left ample room for slick counselors to convince parents their kids needed inpatient care. During a brief conference they could transform a simple act of teenage rebelliousness into a potentially deadly "disorder" requiring immediate hospitalization. Hospitalization typically lasted until the insurance ran out.

As often happens where matters of national policy are concerned, the niche for these white-coated sleaze bags grew from the best intentions. In this case, it was the long overdue recognition of mental illness as a medical -- and hence, insurable -- problem. While there are undoubtedly many fine, honest psychiatrists and hospitals out there, the river of insurance money was too tempting for miscreants to pass up. If persuasion didn't fill beds quickly enough, NME hospitals were not above more coercive tactics. The author rounds up horror stories of teens who were essentially kidnapped on some flimsy pretense (suspicion of a drug problem, for example) then released only after racking up enormous bills.

To her credit, Bing focuses instead on the more complex story of a young girl who actually needed hospitalization and quality psychiatric care. Christy Scheck suffered from serious depression, had hurt herself several times, and demonstrated rage against her family. The Schecks were imperfect parents. Father Bob Scheck, a heman with a military background and a strong desire for a son, delighted in Christy's youthful athleticism but apparently recoiled as she began to develop into a young woman. Mother Merry Scheck, if anything, was guilty of being too passive.

But in the end it is the complexities of the Scheck story that make it so compelling. These are the families, after all, who are most in need of competent care. From the moment Christy was admitted, Southwood's inexperienced and profit-driven staff seemed determined to drive a wedge between her and her parents by supporting the notion that the parents were to blame for Christy's illness. In particular, the staff encouraged, and subsequently endorsed without question, Christy's ever-wilder accusations, including sexual abuse by her father.

Bing clearly believes Christy invented these charges to punish her parents, and presents overwhelming evidence that, whatever Bob Scheck's faults, he was no child molester. But that didn't stop Southwood from egging Christy on, nor did it stop the hospital and government agencies from inflicting a public nightmare on the Schecks that ultimately enveloped not just Christy and her parents, but younger sister Molly as well. As a result of charges that Bob Scheck abused both daughters, Molly was moved to a foster home for a time.

The final injustice of the system was one of simple neglect. On the night she killed herself, Christy sent unmistakable signs to attendants that she was depressed and on the verge of hurting herself. Nevertheless, understaffed Southwood left her alone long enough to hang herself. Then, as a last insult to the Schecks, attendants phoned doctors, staff, even insurance companies, before letting the family know an hour later that their daughter had been discovered near death.

Bing's only missteps in A Wrongful Death involve her tendency to ramble. The author insists on offering complex, distracting descriptions of even the most ancillary characters. An overly long preface oddly recounts Bing's own high-flying life on the fringes of the Southern California cocaine trade during the early 1980s, leading to a brief stint as an orderly in a psychiatric hospital. Her personal connection to the mental health system is too brief and ancient to warrant such a detour, especially at the beginning of the book. Her epilogue, meanwhile, strays from the psychiatric system by indicting the American medical system as a whole -- raising too many issues in too short a space.