A Quiet Little Death at Bellevue
It was the afternoon of May 17, 2007, and Patrick Miller was in the rec room of Bellevue Hospital's 19 North jail ward, indulging in his favorite pastime: propping up gym mats to create a maze and then running and scooting through it, over and over again.
As usual, the 31-year-old schizophrenic man, safe for the past two months in this home away from his homelessness, muttered and babbled as he negotiated the maze.
"Shut the fuck up, Miller," a jail guard assigned to the hospital's rec room told him.
A short time later, at 3 p.m., Miller went to group therapy with about seven other inmates. At 4 p.m., he emerged from the group session and was waving his shirt and dancing in the hallway.
The same guard continued to berate him.
At this point, the details get murky. According to two accounts, the six-foot-one, 200-pound Miller began pacing, and his happy expression darkened into anger. He lashed out by striking a guard—not the one who was haranguing him.
Five guards immediately waded in and beat and kicked the hell out of the mentally ill man. Several struck him repeatedly; one may have bludgeoned him with a walkie-talkie.
A heavily armored riot squad arrived and took Miller out of the ward and into a holding pen in another wing, 19 West.
A short time later, Miller was pronounced dead.
The medical examiner concluded that the "cause of death" was "probable cardiac arrhythmia, following a struggle during agitated episode due to schizoaffective disorder"—in other words, his heart stopped because of an irregular heartbeat brought on by a struggle not with jail guards, but with his mental illness.
Miller's "manner of death" was listed as "undetermined," rather than as a homicide or accidental.
But the actual autopsy report, only recently obtained by the Voice, shows that Miller's body was a mass of fresh bruises, hemorrhages, and internal bleeding—the type of injuries almost certainly caused by repeated blows, and far more suggestive of homicide.
Based on those injuries, a lawsuit filed last week in federal court charges that the guards simply beat Miller to death, that it wasn't his irregular heartbeat caused by his schizophrenia that killed him, but the "massive trauma" caused by the kicks and blows that rained on him.
"It is possible to restrain someone in a highly agitated state without inflicting these injuries," says Jonathan Chasen of the Legal Aid Society's Prisoners Rights Project, who filed the suit. "This is something that is done responsibly all the time."
Another lawyer working on the Miller case, Jonathan Abady, says there is a "disconnect" between the findings in the autopsy and the medical examiner's reluctance to draw a conclusion about the manner of death.
"We believe the blows were fatal," says Abady. "The circumstances are extremely troubling, and raise a lot of questions about why it happened."
Ellen Borakove, a spokeswoman for the medical examiner, declines to comment on the specifics of the autopsy report. She notes that her office's findings can be amended if new information surfaces: "In general, 'undetermined' means we don't have enough information to draw a conclusion," she says. "It means we're not ruling anything out or in."
The Voice pieced together the story of Patrick Miller's final few hours from numerous records and interviews with people close to the situation; most of the people interviewed for this story wouldn't be identified by name or job. Offically, no action has been taken. The Manhattan district attorney has been investigating the case for more than a year now, but a spokeswoman declined to comment for this story. The Department of Correction also declined comment on the incident.
Patrick's mother, Billie Ann Miller, 52, who lives in Spartanburg, South Carolina, calls her son's death "so heartbreaking for me to talk about." She adds: "I feel that justice should be done, because he didn't even have a chance to try to straighten his life up. I feel he was like a kid in his mind."
Bellevue's jail wards are supposed to be the most secure place in a system that, by default, has become one of the largest mental-health providers in the region for the thousands of mentally ill people adrift on New York's streets. These people in need of psychiatric care often wind up not in hospitals or mental-health-care facilities, but in the jail system, or at least in a hospital's jail ward.
Miller's death—which came only three months after another inmate/patient, Joel Noonan, hanged himself in the very same Bellevue ward—raises questions about the level of care and the quality of the training of the correction officers who staff these wards.
Noonan was able to hang himself by slipping down to the end of a hallway on the ward and securing a sheet to a gate. A jail guard assigned to monitor that section of the hallway was not at his post. Following Noonan's death, the Correction Department affixed wire mesh to all of the gates on the ward.
But Miller's death was no suicide, and yet it raised little notice at the time. His body lingered at the city morgue for months because no one could find his next of kin. It's not clear whether the city did anything to locate the family.
His body appeared destined for a grave on Hart Island, where the city buries its unclaimed dead. But a Legal Aid social worker who had gotten to know Miller began a search for his family. Eventually, the trail led to South Carolina and Miller's mom, a machine operator in a factory. Billie Ann Miller told the New Yorkers who found her that she had had only intermittent contact with her son in recent years. A funeral was arranged.
As a child, Miller was interested in books and "was a good listener and artistic," she tells the Voice. "I remember him at 10 months old going to look at books. He loved to draw."
The teenage Miller was in and out of trouble with his friends, his mother says, and she convinced him to enter the Job Corps by offering to buy him a car. After he turned 21, however, he moved out, developed a drinking problem, and had his first bout with homelessness. After his mental illness began to surface, she says, mother and son lost touch.
In 2003, Miller reappeared in Spartanburg and told his mom that he had been living in New York. "I didn't know he had moved there," she says.
Miller was scooped up off New York's streets and put into jail in December 2006 for alleged fare-beating at the Times Square station and alleged possession of a stolen credit card. He was transferred to the Bellevue jail ward on March 22, 2007, likely as a result of his prior history of mental illness.
By then, Miller was calling himself "Jermele Kelly," which happened to be the name of one of his closest friends back home. He often told people that he was from Chicago. Few knew his real name.
People who were acquainted with him say he was physically imposing but almost always docile, even childlike. He often seemed lost in his own internal world. At times, like many other people diagnosed with schizophrenia or related disorders, he seemed to be carrying on a conversation with someone in his brain. He never had any visitors.
Miller had had one previous violent incident: Another inmate punched him, and when a male nurse offered a calming touch, Miller reacted by hitting him in the face and breaking his glasses.
Still, Bellevue's jail wards aren't nearly as rough or foreboding as regular jails. Ward 19 North is a U-shaped hallway with offices and residential rooms arrayed along its length. There are beds for about 25 patients. A second unit, 19 West, has about 40 beds. There are video cameras in 19 North, but none in 19 West—which is significant in the Miller case.
Jail guards are stationed at three spots—a sequence of entry gates, outside the group-therapy room, and a central spot where they can monitor both legs of the hallway. There is also a glassed-in nurses' station.
The medical records for the last day of Miller's life say that he was in "good behavioral control, responsive and respectful," according to the lawsuit. He was on three different medications, but had no history of illegal drug use and no record of heart irregularities, records and sources say.
All of which makes the wording of the autopsy report mysterious: The report concluded that Miller had "multiple blunt trauma," but that wasn't mentioned in the "cause of death" section of the report. Miller had deep bruises on his face, head, neck, and along his jawline. Among other injuries, there were two long internal hemorrhages in his back. In his abdomen, there was internal bleeding.
He had what's called a mesenteric hematoma, an uncommon abdominal injury that occurs when someone is struck hard without warning—like when a baseball player is hit by a pitch.
Miller had also been struck at the point of his sinoatrial node, the nerve in the heart that regulates the heartbeat. Cardiac arrhythmia—or irregular heartbeat—isn't mentioned or supported anywhere else in the autopsy report, except in that single sentence in the "cause of death" section.
Other records in the case—or their absence—generate other mysteries: Miller's fateful encounter with the guards in 19 North was captured by videotape, but what happened after he was taken, unconscious, to the holding pen in 19 West was not.
The incident took place at 5:09 p.m., according to some records, and he was discovered "unresponsive" at 5:20 p.m. What, if anything, happened in those 11 minutes?
Another question is whether the jail guards immediately told hospital staff that Miller was in dire medical trouble. There seems to have been some delay. Sources say that officers appear to have tried to revive Miller themselves. At one point, one of the officers burst into the nurses' station, looking for a plastic bag and a defibrillator, sources say.
Eventually, a doctor on-site, Li-Wen Lee, arrived and went to the holding cell. Still in question is whether Lee was paged by Department of Correction staff or found out on her own and went to the holding cell herself.
The doctor tried to revive Miller for approximately the next half hour, records indicate. He was declared dead at 6:02 p.m.
Where was the jail ward's nursing staff during all this? Under a 1991 federal-court decree, nursing staffers—not correction officers—are supposed to handle or restrain inmates who become violent.
That case, also filed by the Prisoners Rights Project, stemmed from prior brutality by correction officers at Bellevue. According to what's known so far, no nurses were involved in restraining Miller. It's possible, sources say, that the guards warned off the nurses because one of the guards had been struck.
Insiders say that Miller's death brings to light an already existing turf war between the hospital staff and the correction officers. The two groups operate under separate supervision and often clash over policies and procedures.
"No one really knows who's in charge," says an insider at the hospital. "It's like they're in two separate worlds."
In the wake of Miller's death, the jail guards are now required to notify the nurses whenever they remove someone from the ward. And a nurse must accompany the inmate to the holding cell and monitor him.
Such policies can help, but sources tell the Voice that although some of the correction officers work well with the staff and inmates, others will verbally abuse the inmates and are difficult to work with.
The guards get at most only a few hours of training before beginning to work in Bellevue's jail wards—and none of that training comes from the hospital's staff.
Officials say they've been trying to improve communications between the guards and the nursing staff: The two groups now hold a joint briefing during shift changes. And in what seems to be an unofficial change, the guards evidently have been ordered not to handle the patients at all, but rather to leave the job to the nursing staffers.
Some insiders say there just aren't enough jail guards to safely monitor the inmates. And they question why the officers involved in the Miller incident weren't removed from the floor pending an investigation.
If the details of Patrick Miller's death are still incomplete, his mom is at a complete loss to understand exactly what happened on Bellevue's 19 North ward.
"I just feel like everyone knows the Commandments," Billie Ann Miller says. "If he was there to get help, I feel there should have been a different tactic that they could have used for him."
Having lost touch with her troubled son, then regaining contact, and then losing him altogether still obviously pains her a year after his death.
"He told me he was living in Harlem and getting some help at a hospital," she says. "I told him I would come up and see him sometime. I never did get a chance."
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