. . . again. And now the real work of his loved ones, the work of keeping him alive on the Vacaville streets through the Covid-thick winter, commences. Again. Because no city or county or stage agency cares. Still.
Mark Rippee of Vacaville, California, has entered what may be the final struggle for his catastrophic life. His survival prospects are not good.
Most readers of this blog know about Mark’s grotesque misfortunes that span thirty-three years. And about the shocking indifference to them among the social services and the members of the Solano County Board of Supervisors. To refresh your memory, click on this blog link to read my previous posts.
Mark was released from a Vacaville hospital on October 26. He had spent two hundred fifty-eight days there, the longest respite of his tortured life since June 1987, when a motorcycle crash left him blinded, his body shattered, parts of his brain exposed, and his mind vulnerable to the schizophrenia that soon struck him. He’d been hospitalized after being struck by a car for a second time while wandering sightlessly around the town.
No agency in the city, the county, or the state of California cares about Mark Rippee. The attached links detail how his sisters Linda Privatte and Catherine Hanson, both women in their 60s with major illnesses themselves, have tried in vain to obtain conservatorship over him and to find a secure place for him to live. The care agencies and political bodies enfold themselves in narrow interpretations of law and policy. The sisters believe that in fact some laws meant to protect people such as Mark have been violated, with no one inclined to enforce them.
The family has been helped, materially and spiritually, by a growing army of concerned friends and Vacaville citizens. The sisters have posted a call for blankets, food, medium-sized long-johns and lined sweatpants, beanies, deodorant, lotion, hand sanitizer, baby wipes, a coat, gloves, socks. And water. Always water.
To simply read this sad list is to recoil at the scale of difference between Mark Rippee’s plight and the stony disdain—the contempt—of the agencies and the political structure designed to help him.
The charity now arriving is a godsend, and a tribute to the humanity of Vacaville’s private citizens. Yet it is not enough to assure this broken man’s survival. Mark, now 57, remains vulnerable to winter’s ravages, to further collisions with cars and trucks, and—most threateningly—to his environment’s rising Coronavirus rate. Solano County has entered tier 2, the “red” tier, which signals a “substantial” level of infection.
No one tells Mark’s story with more passion and clarity than Linda and Catherine, who have told it to deaf ears for three decades. Their stories and updated reports are linked below.
Today is a dark day. Mark was discharged from the Acute Care hospital after 258 days of healing from his injuries after being struck by a car for the second time in the last year. He was taken by the facility’s van back to the streets of Vacaville. He left with only a cane, duffle bag, boots, and 2 sets of clothes. They gave him 1-2 months worth of medications but would not confirm what they were. I don’t know how he will know what he is taking or when it is time. He has been on increased Anti-psychotic meds recently and I do not know if he will be on the streets. His new Social Worker is with Solano APS and is the same one who did the “Snapshot Assessment” of Mark and declared him “Not Conservable.” He was planning to meet Mark on the streets of Vacaville to “Receive” him back to town. When we called the facility this morning to check on when he was to be released and how… he was already gone. The nurse claimed, “Oh he is not going back to the streets, but is going to the Vacaville county building!” I started explaining that he is going back to the streets! That is where he has lived on the streets for years! I have 2 people trying to help with getting him a new ID. The facility could not confirm if he even had a blanket. He was supposed to get a flu shot before leaving – he didn’t. We have already put together many things he will need, but with a bad leg and a shoulder that doesn’t work, it will be even more difficult to carry much. He is supposed to still be using a walker – but chose a cane. He will have difficulty social distancing and not touching everything he comes in contact with. They said they gave him a few masks. His discharge was scheduled for 11 am this morning. I tried calling all morning and couldn’t reach him or the Social Worker. It turns out they released him earlier than 11 am, so he was already gone before I could even talk to him. I did not even go to bed last night thinking that tonight Mark will be sleeping on the streets. CJ has been up for two nights bracing herself for his release. His drastic improvement over the last 8 months was not enough proof for the county to comprehend that housing, treatment, and care was exactly what was needed in his case. I am back to taking it day by day to keep him alive. How long before another traffic accident or injury? We know it won’t be long… and we will go back to jumping every time the phone rings.I just received verification from one of our members that he arrived at the Carroll Building in Vacaville and the APS Social Worker was not there! He is now alone and darkness comes.Linda Rippee
The Road Ahead… by Linda (Rippee) Privatte Updated June 1.
This fine piece by Jocelyn Wiener appears in the February 26 edition of CalMatters, a probing independent journal based in Sacramento, California. Yet the horrific saga of Mark Rippee, the symbol of mental healthcare decadence in America, a bit of human wreckage stranded on the streets of Vacaville for 13 years, remains mostly hidden in plain sight.
It is time for national investigative outlets to shine their beacons. Where is PBS Frontline? 60 Minutes? 20/20? Dateline? The Weekly? National Public Radio? The Center For Investigative Reporting, right next door to Mark in the San Francisco Bay area? Mother Jones in San Francisco? The Bureau of Investigative Journalism? Pro Publica? RealClearInvestigations?
For God’s sake, investigators, do your duty. Mark is running out of time.
For those reporters interested in a quick backgrounding of Mark Rippee’s story, please check my blog, noonecaresaboutcrazypeople.com. You will find entries about him here, here, here, and here.
You may also review the Facebook thread Mark of Vacaville, kept by Mark’s sister Catherine Hanson.
Secrecy, official neglect, pain, petty violence and thievery have been the daily portion for Mark Rippee during his ghastly, 13-year ordeal of homelessness on the streets of Vacaville, California.
Thanks to the heroic determination of his sisters Catherine Henson and Linda Rippee, a groundswell of activism is at last forming in his defense. Please, no matter what state you live in, sign and return this petition below to help bring a measure of humanity to this terribly violated man!
My brother, James Mark Rippee, who is blind, brain-damaged from a traumatic brain injury (TBI), physically disabled, and has Schizophrenia and Anosognosia. (Lack of Insight to his own serious mental illness.) He has been homeless for 13 years living on the streets of Solano County in California.
I previously authored a petition two years ago in support of AB 1971 in California – legislation that was pulled by the authors after I garnered 82,000 signatures through my petition which was hosted by Care2, due to “poison pill” amendments forced into the Bill to change the definition of “Gravely Disabled” to include “lack of capacity and medical need” as a criteria for involuntary treatment and placement or LPS Conservatorship.
I had made my brother the face of that bill. After continuing our efforts to get him help, services, treatment or placement and failing with our County of Solano in California who have been negligent in their duty to start an LPS Conservatorship Investigation and process, and denial of participation with Laura’s Law, and even denial of Mental Health Services!
We continued to speak at Solano County Board of Supervisors’ meetings and inform all County officials, Health & Human Services, Social Services including Adult Protective Services that he was in danger – in particular to being struck by a vehicle or causing an accident because he literally has no eyes.
In September of 2019, he once again fell into traffic and was struck by a car. Because he has anosognosia and is not of sound mind, when EMTs were called to the scene – he denied needing help and was left on the sidewalk -injured, in pain and crying.
Eventually, he was found by our family two weeks later with life-threatening injuries sustained in that accident. He had emergency brain surgery and was in the hospital for 3 weeks. Although clearly delusional the psychiatrists there refused to declare him with diminished capacity which would have resulted in a 51/50 hold. Even though they would not place a hold on him for his own protection – they did continue to inject him throughout his stay with antipsychotic medications.
Upon their decision to release him and after much protest and contact from the community and mental health advocates from across the nation – accusing them of “patient-dumping” – they decided to transfer him to a Senior Board & Care home (he is not yet a senior) for 30 days under the guise of a “Safe-Discharge Plan.”
Because the Board & Care home was ill-equipped to deal with a person with serious mental illness and his delusional behavior even though Kaiser continued prescribing him antipsychotic medications — they opened the front door and let a blind, severely and gravely disabled man walk away from the facility in an unfamiliar city. Our family lost contact with him as he fled from his delusions to another city for a month.
Through many attempts to get the County to take appropriate action for him and our family – the County of Solano has continued to fail– at this point clearly negligently and with intent to discriminate.
On February 12, 2020, James Mark Rippee was again struck by a vehicle – this time so critically injured that it will take months for him to recover – if he does. He is in Critical Condition with a Fractured Skull & Brain Bleed, Facial Lacerations & Bruises covering his body, Lung Contusions, a severely Dislocated Shoulder, a Shattered Elbow, Removal of the Metal Rod running the entire length of his leg which had been holding his leg together for 34 years and was bent in the accident, a shattered Tibia, and more. It is expected that many more surgeries will be needed and months in the hospital.
At the time of this writing, the hospital is once again denying that he has diminished capacity and has taken no action to allow family members any rights to know about the details of his condition (HIPAA) and even though my brother is incoherent and sedated – they will not allow family members who love him and know what is best for him to make any medical decisions and are ignoring their duty to declare him with diminished capacity in the face of their previous records on him from 4 months ago.
While we hold the County of Solano and many officials, departments and agencies responsible for not preventing this second tragedy that we told them would happen – We also demand that the State of California and in particular – Governor, Gavin Newsom – whom we have previously attempted to contact – PAY ATTENTION TO THIS SITUATION and ACT accordingly!
Our family has contacted many, many politicians at the County, State, and Federal levels for several years! We have testified at the California State Capitol for several proposed legislation regarding Grave Disability, Conservatorship, and pleaded with all to help our family.
We DEMAND attention from Governor Gavin Newsom, who claims to hold in such regard the need to help the Seriously Mentally Ill and the Homeless! NOW!
The voices of the growing grass-roots movement to reform mental healthcare are at last rallying to demand justice for perhaps the most dispossessed victim in America.
In a town in America, here in the Twenty-first century, a man has been left to die. A maimed and blind and deeply mentally ill man.
He has been left to die in this town for thirteen years. Right out in public, on the city streets, where everybody can see him. And beat him and rob him when they feel like it. And nobody with any statutory power over his predicament seems to give a damn.
A technical clarification: this man is not on the streets of Vacaville as I write these words. He is in critical condition in a hospital, bandaged and splinted and broken after being struck by a car at a traffic intersection at dusk on February 12. (It is the second time this man has been hit.)
His injuries include a fractured skull and bleeding from the brain, facial lacerations, lung contusions, a dislocated shoulder, a shattered elbow, a decimated leg, and bruises that blanket his body.
But it’s a safe bet that after the surgeons have him all fixed up—it could take months—he will be ushered back out onto the streets, where the cars he can’t see and the thugs whom he cannot fend off will help him resume his accustomed existence.
The man has a name: (James) Mark Rippee. The city has a name: Vacaville, California. The situation has a name: depraved indifference to the survival of a human being.
I just made that name up. Actually, I borrowed it from legal parlance. Its definition: “Conduct which is so reckless, wanton and deficient and lacking in regard for the lives of others as to warrant the same culpability as the individual who actually commits a crime.”
Here is the crime that Mark Rippee has committed: the crime of existing while crippled, blind, and insane. Are there any questions?
I’m sure there are lots of questions. I have lots of questions myself. Or I used to. I have written so often about Mark Rippee since I became aware of his plight that the words I write about him seem to turn to dust. I have written blog posts about him here and here and here. I have written speeches to mental-health reform groups in which I summarize his story. I have written directly to media outlets, to lawmakers, and to civic leaders in Vacaville and elsewhere. And the streets still claim Mark Rippee.
The bare-bones story—as it were—is that Mark Rippee was involved in a terrible motorcycle crash in June 1987, at age 24, that left him nearly dead, with bits of his brain scattered near the site, his eyes and his right leg destroyed. You can read the details in my links.
Somehow he survived. But over the years, his traumatic brain injury (TBI) has morphed into schizophrenic-like thoughts and behavior. His power to reason vanished. His mother and his twin sisters Linda Privatte and Catherine J. Rippee-Hanson tended him in the family household for eighteen years, until his deformed brain turned him into a raging menace. He left the household and has made his way on the streets, where his sisters—both of whom have developed serious illnesses of their own—bring him food, clothing, canes. Vandals keep stealing all of it, and often also the money given him for food and other needs.
Why doesn’t somebody rescue Mark Rippee? Why doesn’t some agency . . . why doesn’t . . .
Those are very good questions, and I’m glad you asked them. But the answers are buried within the folds of incoherence that comprise so much of the American mental healthcare system. Or systems. Or “systems.”
Mark Rippee is a victim of a perfect storm of gothic bureaucracy. The pertinent bureaucrats at Solano County and California state levels have exhibited no discernible interest in finding any way to counter the bureaucratic snafus with a humane solution that would get this man into supervised care and treatment.
One might even say that they are hiding behind a “humane solution” that actually exists. This solution would begin with a declaration from a psychiatrist that Mark Rippee’s accident left his brain with “diminished capacity.” This ruling would permit Mark’s family to place him in an appropriate facility and/or to establish a conservatorship that would give them discretion over his affairs, including psychiatric care.
No dice: hospital psychiatrists have consistently, and weirdly, denied that Mark Rippee has “diminished capacity.”
And the reasoning behind this confounding denial? Well, it’s none of your business what the reasoning is. The hospital is protecting Mark Rippee’s rights, you see. Protecting them by way of the cartoonish Health Insurance Portability and Accountability Act. HIPAA was designed to ensure a patient’s “privacy.” “Privacy” that prohibits even family members from learning the medical procedures and condition of a patient. There’s an irony there, in case you missed it.
Catherine and Linda have fought tooth and claw, over parts of three decades, to tear through the self-serving laws and policies that keep Mark in a near-feral state. Two years ago, Catherine plunged into work on a petition in support of a California bill known as AB 1971. AB 1971 would have expanded the existing definition of “gravely disabled” to include medical treatment for a patient if the lack of treatment “may result in substantial physical harm or death.” It would have secured treatment for Mark Rippee. Catherine collected 82,000 signatures in favor of the petition.
In April 2018, the Disability Rights Education and Defense Fund, one of several lobbies that oppose conservatorship and deny other needs of the mentally ill, signaled that it disapproved of AB 1971. The California Hospital Association also weighed in on the negative side.
AB 1971’s sponsors pulled the bill.
The sisters’ determination would be the stuff of heroic legend, if we lived in a country that valued heroic legend. In the wake of Mark Rippee’s second brush with death by an oncoming car he couldn’t see, Catherine has released a new petition. It demands intervention from California Governor Gavin Newsom to rectify this travesty of public policy. It reads in part: “While we hold the County of Solano and many officials, departments and agencies responsible for not preventing this second tragedy that we told them would happen – We also demand that the State of California and in particular – Governor Gavin Newsom – whom we have previously attempted to contact – PAY ATTENTION TO THIS SITUATION and ACT accordingly!”
Here is a link to the petition.
Moreover, thanks to the sisters and the Internet, word of Mark’s ordeal is spreading at the grass-roots level. Activists around the country, alerted to the nightmare, have begun writing letters demanding justice for Mark.
Here are two. Their tone of indignation and urgency is echoed by many more.
From Donna Erickson of Massachusetts:
“Hello, I’m writing to voice my concern, in regard to a homeless individual named James Mark Rippee. As you probably know, he is severely disabled both mentally and physically. Being blind only further complicates his poor condition. The real tragedy here is that none of this is his fault. Severe mental illness is a disease nobody chooses. Many who are afflicted are unaware of how sick they are, because of anosognosia, which is lack of insight, a condition that is a manifestation of the illness itself. It is not his fault that he repeatedly walks into traffic.
“His brain is broken, and he cannot see. Someone in this condition should never have been put on the street. So now he is hospitalized for another accident, resulting in critical injuries, including a skull fracture, brain bleed, and broken bones. He will need many surgeries.
“His family is devastated, because they tried so hard to get him off the streets. But the laws get in the way. This poor man requires a hospital, rehab, and eventually a long-term residential facility. If he is an elopement risk, then there are locked facilities. Mark’s value as a person is no less than any of us on Earth. He has fallen through the cracks of a very broken system.
“How would you feel if this was your family member? Mental illness can strike anyone. He is not a nobody. He is a family member of caring individuals who have tried everything in their power to help. The tragic part is that this all could have been avoided, if only someone had truly cared and listened. Keeping someone on the streets in his condition is disgraceful. And it shouldn’t matter what he says. He is unable to make a rational decision, which is in his best interest, due to his illness.
“The system has failed him, because no one intervened, even though the family had begged and pleaded. I had to voice my concern, because this could have been my son. This could have been anyone’s son, and we need to start taking care of our most vulnerable citizens!”
And from the Maryland advocate Laura Pogliano:
“My friend [Catherine] Hanson and her sister Linda Rippee have been trying to help their brother Mark for 13 years; a motorcycle crash left him with no eyes, a severe brain injury, broken bones all over his body, a metal rod in his leg, and as a result of TBI, schizophrenia. He’s been on the streets for years, being victimized, robbed, beaten and neglected. They’ve been denied help for him over and over by the county they’re in, by hospitals.
“He’s been admitted to, by group homes, by every support service you can think of. He was hit by a car a few months ago and while inpatient, one sister’s medical power of attorney was revoked, and the psychiatrist sided with his delusional raging patient, that he was capable of making his own medical choices and caring for himself (blind and floridly psychotic). He was discharged to a group home and lasted about a week.
“Now, living on the streets, Mark’s been hit by a car again! Only this time, he was thrown into the air and smashed his face against the driver’s windshield. He’s in bad shape, has another brain injury, the leg with the metal rods is shattered, his shoulder is dislocated and he might lose what’s left of his teeth.
“He’s going to need months of hospitals, multiple surgeries, and extended care. And guess what? He’s in the same damned hospital that battled back against his family and discharged him to the streets.
“Mental health care in America. You stand a slight, very slight chance of making it, if you’re healthy enough to ask for help and participate in it. If you’re really, really sick, you’re screwed.”
In a city in America, here in the Twenty-first century, a man has been left to die. But in America, the voices of reclamation are arising to insist on his right to live.
“There is a crime here that goes beyond denunciation. There is a sorrow here that weeping cannot symbolize. There is a failure here that topples all our success.”John Steinbeck
Vacaville, California, has a history of popular uprisings to confront the powerful as they violate the humanity of the dispossessed.
In 1932, organizers came to Vacaville to organize the Cannery and Agricultural Workers’ Industrial Union, which fought the starvation-wage exploitation of farm and orchard laborers by the state’s powerful growers. The CAWIU went on strike that December–one of 140 strikes, some of them violent, that occurred between 1930 and 1939. These actions caught the attention of John Steinbeck, and triggered his impulse to write The Grapes of Wrath, which won the Pulitzer Prize in 1940 and contributed to his Nobel Prize for Literature in 1962.
Now Vacaville finds itself at the tipping-point of another defining moral struggle pitting society’s outcasts against entrenched power. The outcasts in the current showdown, the homeless mentally ill, are represented by James Mark Rippee, the blind, gravely brain-damaged street dweller of whom I’ve written extensively on this blog. The power centers that control his fate are the extravagantly named Kaiser Permanente Vacaville Medical Center, and the Solano County Board of Supervisors.
On Tuesday, October 8 (tomorrow, as I write this) one or both these institutions will render decisions that will either end Mark’s twelve years of unimaginable suffering on the small city’s streets, or cast him back into the chaos and brutality of those streets as if he were a leper from the slums of New Dehli.
Mark Rippee is 56 now; emaciated, sickly, and delusional, as he has been since the motorcycle accident in 1987 that cost him his vision, crippled him, and left bits of his brain scattered in an alfalfa field.
Winter is coming on. Mark has routinely been beaten and robbed over the years by random thugs who have taken a succession of walking sticks his sisters have provided him, as well as blankets that have been his only insulation against the cold.
His age and failing health augur against his surviving the cold months out-of-doors one more time. The ongoing, unfathomable indifference of the County board to his physical exposure, and the equally bewildering failure of Kaiser Permanente’s psychiatrists to find anything wrong with his psyche, augur against his rescue by those whose charge is the public health and safety.
The “policy” decisions on October 8 at the Kaiser Permanente Vacaville Medical Center and the Solano County Board of Supervisors, then, probably amount to a life-or-death sentence for James Mark Rippee. “Policy” explains why Mark Rippee remains homeless. The pertinent “policies” ensnarled in the maimed reasoning of brain-damage victims and in the equally maimed consciences of bureaucrats. “Policies” have constricted his sisters, Linda Privatte and C.J. Hanson, as they have struggled to gain simple shelter and medical care for their brother, whose fog of reasoning blocks him from giving necessary consent.
Mark is in the hospital because on September 14 he stumbled into traffic and was hit by a car as he wandered blindly along Monte Vista Avenue in Vacaville. The impact knocked his head against the concrete and re-opened an abcess. The pain overcame his delusional resistance to being hospitalized or treated (a common resistance, known as “anosognosia,” or lack of insight, in schizophrenia victims).
Mark Rippee’s hospital stay seems likely to end on October 8, when the Kaiser Permanente Vacaville Medical Center will release him to–well, it will release him. It is not the “policy” of the Kaiser Permanente Vacaville Medical Center to give much of a rap where patients such as Mark Rippee end up. “Policy,” you see, allows no moral dimension. It normally is accompanied, however, by a burning desire not to spend money.
And on this same day the bureaucracy known as the Solano County board of supervisors will hold yet another hearing to hear opinion on whether Mark Rippee’s sisters should, at last, be granted a conservatorship that would allow them to make decisions on his behalf. Conservancy, like hospital and psychiatric care, requires the expenditure of money. Such money is sometimes available through state and federal government. But then there is that annoying matter of consent by the patient.
One thing will be different, in Mark Rippee’s favor, on this Tuesday. Public opinion is at last beginning to coalesce in his favor. The sisters’ exhaustive efforts at rallying community support have started to pay off, in the form of rallies and an expected turnout at the supervisors’ hearing. Advocates around the country are on standby, alerted by Facebook postings. A T-shirt is available for purchase online. It bears Mark’s ravaged likeness and the declaration that he blurted out, surprising everyone, during his recuperation. It should serve as a manifesto for all his brothers and sisters on this country’s streets:
“I am NOT homeless! I have a home! My home is the United States of America!”Mark James Rippee
On Tuesday, October 8, we will see whether the United States of America fulfills Mark Rippee’s cry of trust.
-Catherine Rippee-Hanson, a sister of James Mark Rippee
Mark Rippee has survived on the streets of Vacaville for nearly twelve years despite being sightless, missing parts of his brain, enduring the pain of an interior metal rod to support his shattered right leg, fifty surgeries—many of them to heal the wounds he has suffered from repeated beatings by passing thugs. . .
. . . And, oh yes: despite his diagnosis of acute schizophrenia (a diagnosis that, weirdly, Mark’s family cannot definitively confirm because of restrictive and nearly useless laws).
Mark Rippee is one of more than one hundred thirty thousand homeless people in California as estimated by the Department of Housing and Urban Development. Most of them are unsheltered. That figure amounts to one-fourth of the national homeless population (553,742). As one legislator wrote,
“Homelessness and homeless encampments have become a part of the permanent landscape of California.”
As hundreds of millions of dollars in new-housing money languish in law-court entanglements, the death toll among California’s homeless has been rising: infections, pneumonia, cancer, cirrhosis, and other treatable diseases claim ever-more victims. In 2017, eight hundred thirty-one street people died in 2017, nearly doubling the count of 458 in 2013.
A Los Angeles County study reported by Politifact reported that more than one-fourth of the homeless are seriously mentally ill. Other estimates place the figure at one third.
The homeless mentally ill (in California and elsewhere) exist under twin, paradoxical curses: they are public eyesores. Pedestrians grimace as they step over their inert forms or cross the street to avoid their wild gestures and ranting.
At the same time, they are invisible: faceless statistics, generic, interchangeable, somehow less than human because of their madness.
Mark Rippee is one of these living paradoxes. Perhaps he should be their national symbol. His nearly faceless face is the face of the faceless: the face of our gravely disabled brothers and sisters who live and suffer and howl and die, bereft of help from government, agencies, and many churches, on the streets of our cities. Force yourself to contemplate what is left of Mark Rippee’s face for as long as you can stand to hold his sightless gaze and think about the obscenity of your country’s mental healthcare system.
This is a man who is severely, gravely disabled, living on the streets for 12 years. –Catherine Rippee-Hanson
Thirty-one years ago, Mark Rippee was a handsome and hopeful young man. At age 23, he was a productive member of the Vacaville community, a robust construction worker with a girlfriend, still mapping his life-plans.
Those plans blew to bits in an instant on the Sunday night of June 21, 1987—Fathers Day. On a dark country road, astride a Harley-Davidson motorcycle that he had owned for only a few days, Mark swerved to avoid an oncoming car that had drifted into his lane and tore through an alfalfa field until the bike ploughed at high speed into a grain harvester.
This is a man who left massive amounts of grey brain matter from his Frontal lobes lying in a dark field. This is a man who paramedics transported without sirens at first, thinking he must be DOA. –Catherine Rippee-Hansen
The impact tore a deep T-shaped gash across Mark’s face, destroying his eyes and exposing his frontal lobe, grey bits of which were found around him. His right leg was ripped open from his crotch to his ankle and broken in several places The EMTs who loaded him into an ambulance assumed he was dead until they noticed movement en route to the hospital.
Mark Rippee survived his shattering injuries. His accident, however, struck hard at his close-knit family. His father James suffered a breakdown soon afterward, entering a state of denial that led him to prohibit Mark’s twin sisters, Linda and Catherine, from securing Mark’s commitment in an institution. Six years later, James Rippee suffered a stroke and died. Mark’s mother, Lou, now 78, also commenced a long, slow decline in her health.
For eighteen years Mark managed to live at the borders of a peaceful and secure life, given the givens. His mother and his twin sisters (both of whom married) threw themselves into his welfare with the aid of a part-time caregiver. At intervals, and with support, Mark could maintain his own apartments.
The three women kept hope alive. They never lost their love for the invisible man beneath the disfigurement and the ravaged brain.
This is a man who was described as sweet, caring, willing to share whatever he has, and intelligent. –Catherine Rippee-Hanson
That hope eroded with each of the twenty-odd operations on Mark’s brain to scoop out abscesses (Mark has undergone more than fifty operations in all). Each brain surgery eliminated more grey matter. Each elimination weakened Mark Rippee’s capacity to think clearly and increased his tendencies to erratic, threatening behavior.
“He lost control of his emotions, his anger management, his reasoning,” said Linda. “There was no filter. Since the accident, he has fought depression, sleep disorder, and chronic unimaginable pain.”
Mark hallucinated. He heard voices, spoke in the personas of three different people.
“He called Travis Air Force Base several times to report that aliens were attacking,” Linda (by then Linda Privatte) said. “A voice told him to take a fork and pluck my daughter’s eyes out. He chased me with a stun gun, he began to have conversations with himself and 2-3 other people in his head.”
Mark’s psychosis deepened. He barred his mother from his apartment, yelling that he would kill her if she came in—he did not believe it was his mother. The sisters feared he would hurt her. His mother stopped caring for him; after twenty years the stress on her was taking a toll. Shortly afterward Mark was evicted for starting a fire outside his apartment door.
“He was suicidal,” Linda continued. “Mom wrestled a loaded gun from him. He has walked into traffic and tried several times to jump from a moving car. He has tried twice to jump off an overpass twice. He hates us all for saving him.”
Mark Rippee clearly was now beyond the family’s control. A few years earlier, a psychiatrist had diagnosed the young man as afflicted with paranoid schizophrenia. But Mark’s delusions had by then swept him well beyond the capacity to assent to therapeutic treatment or medications.
The sisters began to search for a therapeutic sanctuary and psychiatric care. In doing so they entered a labyrinthine world, a world that often mystifies most Americans, including relatives of the mentally ill: a world of bureaucracies piled upon bureaucracies: municipal and state government, psychiatric hospitals, police departments. A world of strange acronyms (CBT, CET, CMHC, AB, ADC, HHRMAC, SB, SHIP, SHOP—the list extends into the hundreds.) Behind the acronyms stretched a thicket of rules, restrictions, policies, protocols—all designed, it seemed, to pass the buck, evade accountability, and keep the mentally ill as far as possible from reclamatory help.
The years pass, and the trail of the sisters’ efforts grows long, convoluted, chockablock with blind alleys, false leads, rebuffs, personal humiliation. Not even Linda or CJ can fully reconstruct its nightmare skein.
Among the most infernal of the acronyms was HIPAA.
HIPAA: the Health Insurance Portability and Accountability Act. Congress created HIPAA in 1996. Essentially, it is a misbegotten tool for ensuring the informational privacy of a patient in the health-care system. In practice, HIPAA has deprived countless thousands of family members from information vital to helping them understand what is wrong with their loved one, and what to do about it. Leading advocates for mental healthcare reform have insisted that HIPAA be either radically reconceived or scrapped.
HIPAA rules prevented the Rippee family even from being able to confirm that diagnosis of Mark as a paranoid schizophrenic. (It was relayed to them by a mutual friend of the psychiatrist.) Nor could they ascertain his medication needs.
Nor could they—can they—even have him removed from the brutal mercies of the Vacaville streets and placed safely in an institution. They were—are—stymied by the monumentally absurd, fatally ambiguous system of state laws that sprang up at mid-century to counter the unintended consequences of deinstitutionalization. These laws awkwardly attempt to protect the civil rights of mentally disabled people on the street (140,000 as of 2015, as estimated by the Department of Housing and Urban Development) against involuntary commitment to therapeutic care: unless, that is, if the individual can be judged “a danger to self or others.”
The absurdity of this standard radiates from its description: how is it possible to prove that someone is a danger to self or others unless that person commits an act that is—well, one can see where one is going with this. Yet even committing such an act is no guarantee that the perpetrator will be taken under care. Consider the case of—oh, James Mark Rippee: the loaded gun. The stun gun. The threats of suicide. The threats on his mother’s life. The fire he set. The attempted jumps from moving cars and overpasses.
Yet as I write these words, James Mark Rippee remains blindly, madly, on his own; a man, in effect, without a country. Certainly without a country that gives a damn whether he lives or dies, as long as he just stays the hell out of sight.
This is a man who has no safety net at all, but has the right to die on the streets, because he can say, “No.” –Catherine Rippee-Hansen
Linda and Catherine—the latter by now suffering from cancer that has been diagnosed as terminal—turned their energies to another strategy that seemed reasonable: securing hospitalization for Mark as “gravely disabled.”
“Gravely disabled” describes one of the several lurching measures to slap a tourniquet over the worst bleeding wounds of deinstitutionalization. Encoded in two similar bills, AB 1971 and AB 2156, “gravely disabled” is the standard for which the state would intervene in an uncooperative homeless victim’s life and usher that person to shelter and treatment. A person is considered gravely disabled if he/she is unable to. provide for basic needs for food, clothing, or shelter because of a mental disorder of impairment such as alcoholism.
That’s the theory, at least.
Linda and Catherine—Linda, after her sister weakened from her cancer—showed up at meetings of the Solano County Board of Supervisors to encourage support passage of AB 1971. They spoke up. They wrote volumes of emails to the committee.
For their troubles, they found that “gravely disabled,” like “danger to self in others,” resides largely in the eye of the beholder: the eye being that of the agency in charge of enforcing it.
“Over the last few weeks alone, I’ve contacted more than forty-five agencies and people, trying to convince them that my brother is the definition of “gravely disabled,” Linda told me recently. “I told them he needs a conservator [a certified adult overseer], based on his family’s situation and the fact that he has been homeless for more than a decade. While I attempted to have patience, I was only told, “Thanks, we’re working on it.”
That was hardly the worst. After one early petitioning visit, Catherine reported that the Board of Supervisors let her know that they consider Mark self-sufficient “if he can eat out of dumpster. They consider him self-reliant if he knows to cover himself with newspapers, or to sleep under a bush to try to stay warm. They consider him self-sufficient if he can panhandle.” (Other relatives of street-people in the state have reported versions of the same response.)
The sisters rejoiced when AB 1971 was passed by the California Assembly, even though it was stipulated only as a five-year pilot program, and only for Los Angeles County, not the entire state.
They rejoiced prematurely. In late August, after a rash of opposition from groups that included, with splendid irony, the California Hospital Association and the Disability Rights Education and Defense Fund, AB 1971’s sponsors pulled the bill. The Rippees, along with tens of thousands of other Californians struggling to reclaim their helpless loved ones from the California streets, are back where they started:
This is a man who is suffering, body and mind, tormented, and in physical and mental pain every day . . . This is a man who hears voices he hates, like a broken record to the point of pure torment . . . This is a man who had medical doctors abandon him for having angry or unacceptable outbursts . . . This is a man who gets robbed of his income by people who he asks for help to use the ATM . . . This is a man who has family members who under current law cannot make decisions for him to help him . . . — Catherine Rippee-Hanson
With Catherine depleted by her disease and Lou Rippee awash in depression, Linda Privatte struggles on alone to reclaim what is left of her brother.
“I have not been able to as much as look at Mark,” she told me a day or two ago. “I’m feeling guilty about that.”
You are entitled to look away from your brother, Linda (though you won’t, not for long). It is the rest of us who are morally obligated to keep looking into James Mark Rippee’s nearly faceless face, until we accept that this man and all his gravely disabled mentally broken brothers and sisters are our brothers and sisters as well, and that we must not look away until we have inspired or shamed our country into facing them and giving them sanctuary.
For God’s sake, this is a man. He is not invisible. He is not expendable. With any humanity left in us, let us help him. This is a man. This is a man. This is my brother.
Note: on Monday, September 10, I invited two members of the Solano County, CA, Board of Supervisors to respond to comments by CJ Hanson and Linda Privatte that addressed their comments and policy positions. At this writing neither has responded. I will post any comments from them should they come in.
I invite and encourage repostings of this blog entry from other sites, from newspapers and magazines, and from other print and online journals. No further permission is required.