Mentally ill veteran's case highlights justice system's gaps
The Philadelphia Inquirer
Since Leo Bullman was charged with assault after arguing with a neighbor last year, psychiatrists have ruled a half-dozen times that the 68-year-old Vietnam vet is not competent to be tried.
Bullman's schizophrenia has made him volatile and unable to understand and aid his lawyer, experts say.
So it's a good bet Bullman doesn't realize his case has become the source of a struggle between Pennsylvania welfare officials and lawyers over where he should be held as experts try to restore his mental competency.
But almost five months after she ordered Norristown State Hospital to move Bullman from the prisonlike forensic unit to a locked but less restrictive civil, or noncriminal, ward, Philadelphia Municipal Court Judge Karen Y. Simmons has had enough.
"Everybody is placing the blame and responsibility on somebody else and nothing is being done," Simmons told officials at a June 26 hearing.
So Simmons has ordered everyone - state officials, state hospital administrators, and Bullman - to be at a hearing Wednesday where she will consider holding the state in contempt of court for ignoring her March 13 order.
"No one's going to jail yet," Simmons said, musing that she could lock up state Welfare Secretary Gary Alexander for contempt.
"So this is my plan," Simmons told Daniel Fellin, the Department of Public Welfare's senior counsel. "I can't let this continue to fall through the cracks. I'm going to list this for status and then I'm going to impose a $1,000 fine a day until Mr. Bullman is moved."
Fellin and Norristown State Hospital officials argued that they were caught between limited funding and court settlements that force them to transfer responsibility for providing civil mental-health commitment beds to Philadelphia and other counties.
"The civil side is now at its capacity and admissions will become available to patients on the waiting list as current patients are discharged," Fellin said.
Philadelphia mental-health officials told Simmons they were not notified until July 23 that the state wanted to pass Bullman's care to them - not that they have a facility or could afford one on the state's proffered $653 a day.
Bullman's attorney, Gregg Blender, says he thinks the state is "trying to get out of the mental-health business. Leo is caught in the middle of all this."
About 40 years of court rulings involving students, the disabled, and the mentally ill have created a legal principle that people should be confined or cared for "in the least restrictive environment."
What remains in play, however, is how government provides that environment in an era of waning political and financial support.
Bullman's case illuminates the system's failings. He is a criminal defendant who can't be tried, convicted, and sentenced because he is not mentally competent. He is a mentally ill, potentially dangerous man for whom bail is not an option, but long-term, secure, noncriminal mental-health care is largely nonexistent.
"It's really a disgrace that someone like Leo is treated this way," said Blender, a lawyer with the mental-health unit of the Defender Association of Philadelphia.
Bullman is a Marine veteran, honorably discharged after seeing combat in Vietnam from 1966 to 1968. He returned home to Oxford Circle and resumed the ordinary life of most Philadelphians.
Later on, Bullman had problems with alcohol and mental illness. And like others with mental illness, Blender said, Bullman had trouble consistently taking the medications that kept him stable.
Today, Blender said, Bullman's past is mostly a mystery. He said Bullman has trouble communicating with him, so he has not been able to learn anything about Bullman's former job or family life except that he has a son and an older brother in Maryland.
Bullman's turning point was Feb. 10, 2011, when he got into an argument with a neighbor and brandished a hammer. Though he never touched the woman, Bullman was charged with aggravated and simple assault, possessing a weapon, making terroristic threats, and reckless endangerment. Bail was $50,000.
"Even the neighbor said he was a nice guy," Blender said. "She said she only called police because she wanted him to get help."
Given Bullman's military service and lack of a criminal record, Blender said he was a candidate for Veterans Court. Veterans Court is a city court program to help veterans with drug or alcohol problems who are charged with minor crimes. The idea is for vets to get treatment and counseling before they get worse.
The prosecutor agreed that Bullman was a Veterans Court candidate, and on Feb. 25, 2011, Municipal Court President Judge Marsha H. Neifield ordered a psychiatric exam to determine whether Bullman was mentally competent so his case could proceed.
He wasn't, so he was moved from the Philadelphia prisons' small medical wing to Norristown State Hospital's Regional Forensic Psychiatric Center, nicknamed "Building 51."
Under court rules, Bullman would be kept at Building 51 for treatment to restore his competency. His case would be reviewed every 60 days.
With medication, many people are deemed competent after a few months. Bullman was not one of them.
After Bullman's treatment passed the anniversary of his arrest, Blender sought a court order under the state Mental Health Procedures Act to transfer him to the civil unit at the state hospital.
Legally, Blender said, Bullman could be kept at Building 51 in hopes of restored competency for up to the maximum prison term for his alleged crime, not to exceed 10 years.
But for Bullman, that would effectively mean life in high-security confinement - far longer than his sentence if tried and found guilty.
"It's a question of fairness," Blender said.
Someone on the outside may question what difference a change of locked buildings would mean for Bullman.
At Building 51, Blender said, Bullman is in a cell in a locked ward 24 hours a day.
Patients in the civil unit, though in a locked building, live in rooms. They are free to move around and take part in activities. In good weather, patients may go supervised outside on the grounds or on field trips.
"The civil side is a lot less restrictive and much more therapeutic," Blender said.
Not enough beds
State welfare officials say it's a question of numbers - money and beds, and these days, there's a lack of both.
Fellin, the welfare department lawyer, said the settlement in a 12-year-old federal civil rights suit, Frederick L. v. Department of Public Welfare, requires the state to reduce the number of beds in the civil unit at Norristown. The money is to go to Philadelphia and other counties to place patients in community facilities.
The problem, Blender said, is that community-based facilities don't exist for people like Leo Bullman.
The U.S. Department of Veterans Affairs has offered outpatient mental-health services to Bullman, Blender said, but not a secure facility to ensure he does not walk away and stop taking his meds.
Some private facilities accept court referrals, Blender said, but all require the patient be so ill or debilitated as to require 24-hour care. That does not describe Bullman.
Fellin said Norristown's civil side has 179 beds for allocation among 19 counties in Eastern Pennsylvania. But the hospital is also under orders to close 90 of those beds. Fifty-five are gone, Fellin said, and when the rest are closed, the civil unit will again accept patients as beds become available. The problem, Blender said, is that vacancies usually occur when patients die. That means Bullman - even at the top of the waiting list - will likely wait years more in Building 51 - or in prison.
At the July 26 hearing, Judge Simmons did not seem inclined to wait.
"Maybe $1,000 a day will make keeping some beds open seem cost effective," Simmons said.
Contact Joseph A. Slobodzian at 215-854-2985, firstname.lastname@example.org, or follow @joeslobo on Twitter.