The man was 35 and he craved death. Though his medical records would later reveal no previous psychiatric problems, two of his close relatives had just died in rapid succession, and he sank into a depression that grew steadily deeper. One night, he wrote a farewell note, ingested an overdose of prescription pills and lay down to die. Fortunately, a relative chanced upon him, semi-conscious, and got him to a hospital emergency room, where his stomach was pumped. From there he was transferred into a behavioral health unit for further treatment and observation. That could have marked the beginning of a happy ending, but it didn’t play out like that. Within 24 hours, while still under a suicide watch in the care of mental health professionals, the man was dead. A hospital orderly who had failed to make an appointed 15-minute status check on the patient discovered his body, hanging in his room.
“The only reason [the patient] was there is because he was a danger to himself,” says Michael Stacy, 37, the Frisco, Texas, attorney who tried a psychiatric malpractice suit against the medical center. “The hospital has one duty — keep this person alive and protect him from himself,” Stacy says. “He is in the hospital less than 24 hours and every waking moment he is telling staff that he wants to die. He says his greatest moment will be his last breath.” Under such conditions, a status check every 15 minutes was wholly insufficient, the lawyer says, but even that was not done. It was a death that never should have occurred, and he believes the hospital has to be held accountable.
Stacy, a handsome, dark-haired family man with a hint of gentle sadness in his eyes, is utterly impassioned about suicide. A Fulbright scholar, he claims to have read virtually every piece of literature on the subject and knows the numbers inside out. There are, Stacy says, approximately 30,000 suicides in the United States every year. But there are more than three-quarters of a million attempts annually, a number he thinks may be conservative. Do the math: Somehow, suicides are being prevented every day, he says, often simply by friends or family confronting a struggling companion and asking point-blank if death is in their head. But Stacy wants more to be done. Suicide, he insists, is among the most preventable forms of death.
“What’s frustrating is when a mental health professional says that suicides aren’t preventable, period,” he says. “And that’s just a flat-out lie. If they actually do believe that, then do you want your child who may be at risk to a suicide being treated by someone who doesn’t think there is a darned thing he or she can do to prevent their death? Absolutely not.
“When you become a lawyer,” Stacy continues, “you have all these aspirations and you say to yourself that I’m going to really make a difference. I’m not sure that I was really making a difference for many years. But now, doing the type of work I do, I truly know that I can make a difference.”
Dr. William H. Reid agrees. Reid, a prominent psychiatrist from Horseshoe Bay, Texas, sits on the American Psychiatric Association’s Council on Psychiatry and Law. In his foreword to an article by Stacy and his law partner Skip Simpson, published in the Journal of Psychiatric Practice in April 2004, Reid lauds the duo as “two highly ethical plaintiff ’s attorneys” who “spend considerable time trying to improve mental health care and communication.”
Aiding the Opposition
It’s a Saturday night and Stacy sits down to discuss his career over a couple of margaritas and some Tex-Mex food at the local Chuy’s, a cheerfully gaudy restaurant on McKinney Avenue, just on the outskirts of Dallas. It’s been a good, if busy, weekend day for Stacy. His 3-year-old son participated in his first-ever organized sporting event — a soccer game — and scored a couple of goals, while his 7-year-old played in a basketball game. Stacy was there for both. “You talk about therapy; that’s my therapy, being with my kids and watching them play sports,” he says. “When I do that, everything else is out the window.”
The atmosphere at Chuy’s is friendly, festive and noisy — rather incongruous, for a pensive discussion about the nature of suicide. But to Stacy, it’s just shop talk. “By the time a client comes to us, a loved one is already gone,” he says. “We decided that what we really wanted to do was be real proactive and try to do something to make a difference before a life is lost.” Unfortunately, he says between bites of chicken fajitas, psychiatric malpractice is not a shrinking phenomenon. “The problem is that the mental health care field does not regulate itself,” he says. “If it wasn’t for lawyers, psychologists, psychiatrists and psychiatric hospitals would have zero accountability.”
And there you have the thesis of this rising star’s career — keeping the mental health community accountable. The Stacy/Simpson team has carried it a long way, attaining a national reputation in the field of psychiatric malpractice. Most of their case load stems from suicide litigation — essentially wrongful death cases against allegedly negligent mental health professionals and facilities. Their practice was the subject of a widely distributed book, The Suicide Lawyers: Exposing Lethal Secrets by C.C. Risenhoover, and the two have written articles on the subject, spoken publicly and acted as very public advocates for suicide prevention. An article they wrote for The Journal of Psychiatric Practice coaches psychiatrists on ways to avoid litigation, preaching the virtues of documenting their clinical cases — particularly evaluations of suicidal patients — not in order to hand lawyers the rope by which to hang themselves, but rather to steer lawyers away.
The journal piece contains these words to the wise: “Post-suicide entries in a medical chart are looked upon with great suspicion by both lawyers and juries.” And, “We commonly read in the record, or hear in later testimony, that caregivers were satisfied by the patient’s reassurances alone, or that they failed to try to obtain information from other sources. This is music to our ears.”
This advice may sound like a football coach telling the other team how to crush his offensive-line scheme, but that is precisely the point. It’s worth it to keep people alive, Stacy says.
Island in the Storm
Michael Stacy appears the very image of a balanced individual. He worked in marketing and sales before earning his law degree in 1997 from the Texas Tech School of Law, and then spent five years as a defense attorney for Strasburger & Price, representing clients in product liability, health law and legal malpractice. While at Strasburger & Price, he served as an assistant prosecutor under Dallas County District Attorney Bill Hill through a “lawyer on loan” program.
Despite his good fortune and hard-earned success, Stacy admits the job can get to him. “Sometimes I’m so immersed in this type of work,” he says, “I wonder what’s the baseline for ‘normal.’ I consider myself normal, but with all that I see at work in the aftermath Continued from page 23 of suicide and mental illness, which I am close to on a daily basis, once in a while I go home and wonder, ‘Am I normal?’”
He answers his own question: “Part of me believes that there is a purpose for me to get involved in this type of work, that God has a way of believing that I can handle it, that I am emotionally stable enough,” he says. “I realize how fortunate I am. I’ve always had so much support between family and extended family. I’ve always had plenty of shoulders to lean on if I’ve had to. And now I find that I am that shoulder, for my clients.”
It’s good for clients, Stacy believes, for their attorney to serve as a kind of rock during the trauma of a loved one’s suicide. They inevitably feel misplaced guilt, he notes, largely because the mythology of suicide has left them unprepared to recognize or acknowledge its signs until it is too late.
“You always hear attorneys referred to as ‘counselors,’ but I never thought much about the counselor part until I started doing this work,” he says. “Now I understand what that truly means. In my work now, it’s not just a phrase. I truly am an attorney and a counselor.”
The biggest battle to be fought, according to Stacy, is the war against commonplace barriers to suicide prevention — namely myths that dominate people’s attitudes and bar them from reaching out to help a loved one who might be at risk of ending their own lives. Here are a few common misconceptions:
To talk with a troubled person about suicide is to plant the seeds of death.
“It’s just the opposite,” Stacy says. “The best thing you can do if you think you have a loved one or a friend who’s at risk is to bring up suicide. If you’re thinking about asking a friend if they are having thoughts about suicide, most likely they have had those thoughts themselves and usually they are relieved when somebody brings it up. It’s proven to be a very helpful and therapeutic approach.”
If someone wants to die, inevitably they will.
“Most people who commit suicide are very ambivalent about death,” says Stacy. “Part of them wants to live and part of them wants to die.” He refers to this phenomenon as a “psych-ache.” “When the pain gets so great, they begin to believe that the only thing that will make the pain go away is death. If they felt like life was an option and that there was something out there that is better, most people will choose life.”
Only crazy people commit suicide.
The majority of people who commit suicide have some psychiatric disorder, Stacy explains in The Suicide Lawyers, but they rarely exhibit the out-of-control behavior associated with insanity. “Depressed people can get to a point where they think suicide is the only way out. You’ve got substance abuse and dependency that makes a person a suicide risk. Young people often commit suicide because they are impulsive. Elderly people do it because they don’t feel they have anything left to live for.”