Gail Starken was committed to Maryland's Springfield State Hospital last June by two doctors who believed she was suicidal. Her short trip in and out of the institution was routine for a mental patient, state officials say.
When she arrived, one physician interviewed her. She was watched for four days. Then, after an 18-minute hearing at which no doctors were in attendance, she was released by a legal officer who ruled that she belonged in the community.
Three days later, Starken committed suicide.
A 23-year-old Silver Spring woman with a ten-year history of mental problems, Starken got drunk her first night out of the hospital and was found by police sleeping nude in the front yard of a Rockville home.
She then spent the night of June 29 at a Washington shelter for homeless women. At 9:40 a.m. the next morning, Starken lay down on the tracks of the Farragut North Metro station, covered her face with her hands, and waited for an oncoming train. She was the first person to die on the Metro tracks since the subway's operations began in 1976.
Starken's release from Springfield State Hospital three days before her death was the result of regulations established in 1972 to stop abuses of the rights of mental patients, state officials said. Before the present system was set up, they said, many persons who did not want or need to be in institutions were forced to stay there indefintely by parents or doctors.
Gail Starken's family and her doctors contend, however, that her death was precipitated by the lack of balance in the new laws governing mental patients. In the effort to protect patients' rights, they said, the state had denied people like Starken care they desperately need.
Starken slashed her wrist one month before she went to Springfield, and after three subsequent hospitalizations in Montgomery General Hospital, her family believed, as her father, George Starken put it, that "if we didn't get her into the state hospital, she would die."
However, because Gail Starken did not want to stay at the state hospital, Maryland state laws required that she be found to be both dangerous to herself and mentally ill before she could be committed involuntarily.
Further, the new regulations of the State Department of Health and Mental Hygeine, require that decisions on commitment be made be legal officers, not doctors, at judicial hearings which allow doctors to state their case, but not argue it.
Thus, even though the staff at Springfield believed that Gail Starken needed to stay there for four to six weeks, she was released because the lawyer who heard her case believed that she did not really intend to kill herself, and could survive in the community.
According to state officials, about 2,000 of the 6,000 persons involuntarily admitted to Maryland state hospitals last year were released under the hearing procedure.
"I think the regulations should be cancelled," said Dr. Fritz Kobler, the director of clinical services at Springfield."These decision should be made by doctors, not lawyers. Under the present system, we can run into cases like (Starken's). The doctor's report is read at the hearings, but we have no legal representation."
"This does happen," said Clyde R. Springer, the assistant superintendent of the hospital. "It's very frustrating, especially for parents who have been through all kinds of pressure and trauma trying to help their children. It just proves the inadequacies of the system as it now stands."
There are some state officials who defend the present hearing procedure.
"The hearing concept is a good one," said Dr. Stanley R. Platman, the assistant secretary for mental health in the state Department of Health and Mental Hygiene. "The hearing officer is like a judge - he listens to arguments and expert witnesses, and then he makes an impartial decision.
"If a psychiatrist were making the decision, he might be considered biased or not trained in making impartial judgements," Platman said. "You have to look at the other side of this. A lot of times, the two doctors who commit people to the institution are wrong."
In Gail Starken's case, there should have been little doubt about her need for treatment, her parents say.
A tall, attractive and bright woman, Starken had several mental problems that became apparent with her first suicide attempt, at age 13, according to her parents. "We never really understood what her problem was," said Bernadine Starken, her mother.
"There were words thrown at us by all kinds of doctors - manic-depressive, schizophrenic, maladjusted. The only thing we knew is that she was chronically depressed. It was obvious to anyone who knew her that she was very ill."
Gail Starken graduated, with difficulty, from Montgomery Blair high school in 1973, and lived with her brother in Florida for a while before returning to Silver Spring to stay with her parents. She attended nursing school and beautician's school and wandered through a succession of jobs, but her condition never really improved, her parents said.
Then, in April, 1978, her depression reached a crisis stage. On April 4, while at home talking by phone to a local social worker at a crisis center, Starken slashed her wrists. Three days later, she agreed to commit herself to the psychiatric unit at Montgomery General Hospital.
While in the hospital, doctors began treating Starken with lithium, a drug commonly used to ease depression in mental patients. Her parents said that when she took lithium, her condition improved enormously, and she was released from the hospital after three weeks.
After returning home, however, Starken stopped taking the drug, and soon grew depressed again. She was rehospitalized on May 15 for another week. She came home again and joined an outpatient program at the hospital, but her condition continued to deteriorate. "She acted like a total zombie all the time," her mother said.
Montgomery General admitted her for a third time on June 10.
The Starken family was using Medicaid to finance Gail's time in the hospital. After her third admission, they were infomed that her 21-day Medcaid allotment for psychiatric hospitalization was close to running out.
Because the Starkens could not afford to place Gail in a private treatment center, they decided to try to send her to the state hospital, to give them time to try to find help for her problems. "What we desperately needed was a beathing period," said George Starken, a physicist at Johns Honkins University in Baltimore. "We needed to get her somewhere where she would be protected from hurting herself while we figured out what to do."
Her doctor at Montgomery General, Philip Herschelman, agreed. "I believed very much that she was a danger to herself," Herschelman said last week. "She had very unrealistic fantasies and obviously could not handle herself then."
After Herschelman and a second doctor committed Starken to Springfield State Hospital, the staff who evaluated her also reported that she was emotionally disturbed.
Although the staff doctor who interviewed her found that she was not "overtly psychotic," he wrote in his report that "she gives the impression to this interviewer that she has a great deal of potential for suicidal and impulsive acting out.
"Also," the report reads, "she refused to discuss her thinking and reasoning behind her wishes to picket the White House." The staff estimated her stay at "4 to 6 weeks."
Nevertheless, state law required that a hearing be held four days after Starken entered Springfield to determine whether or not she belonged in the institution. The hearing was conducted by a hospital staff attorney. Starken was represented by a public defender, and a hospital social worker came to read the staff report on her condition.
The Starken family was there, but only because they had heard about the hearing by accident. Herschelman was not there; in fact, he said, he was never contacted by the hospital. No other doctor was present.
Before the hearing, Starken had a talk with her brother, Tim. "Her sentences were rambling and really incoherent," Tim Starken said recently. "She could hardly speak clearly. She was scared and angry and obviously very ill. Then, just before the hearing started, she made this big effort to compose herself. It was obvious she was getting ready to act."
The hearing, according to the Starken faimly, lasted 18 minutes. A social worker read Starken's medical reports, then her public defender asked for her release. The hospital staff attorney asked her father to briefly describe her condition. Gail Starken, her family said, was cool and composed as she answered a few questions. She was released.
Her brother Tim drove her home. "All the way she kept sort of babbling, but she kept saying, 'I can't believe I pulled it off, I can't believe they believed all that stuff I told them," he said. "She knew she had fooled them."
She wasn't studied long enough or thoroughly enough," Herschelman said. "The grounds for her release was that she was not really suicidal when she slashed her wrists, which is totally irrelevant. She could have not been suicidal in April and deeply suicidal in June."
Recently state officials have recommended two changes in the hearing process that led to Starken's release, Platman said. This year, the state legislature recommended that the public defenders who represent patients follow up on those who are released and try to ensure that they are adequately cared for outside of the hospital.
In addition, Platman said, a state task force on mental health recently recommended that doctors who commit persons to state institutions against the patient's will be required to appear at their hearings.
Those changes, Starken said, might result in fewer patients being committed who do not belong in the hospital - and fewer cases of patients like Gail Starken being released prematurely.
"As soon as they released her, I knew I had lost my daughter," George Starken said recently. "I knew I would probably never see her again. I just didn't know it would happen so soon." CAPTION: Picture, GAIL STARKEN . . . ten years of mental problems