Air-Marshal kills bipolar patient in Miami

Discussion in 'Psychiatry' started by Anasazi23, Dec 7, 2005.

  1. Anasazi23

    Anasazi23 Your Digital Ruler
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    All over the news: A bipolar patient was shot and killed by air-marshals after he was found running up and down the plane aisle, yelling that he had a bomb in his bag. His wife was pleaded that he was mentall ill, and reported that he needed medication. Authorities would not confirm that he had a mental illness.

    The entire flying experience is fodder for psychosis and thought disorders. Lots of paranoia, being searched, funneled into the plane, constant directions, demands to remove your shoes, being sniffed by dogs, etc. I'm surprised this doesn't happen more often.
     
  2. rpkall

    rpkall Darwin Award Winner
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    This is really a shame.

    The part of me that loves psychiatry wants to be disappointed and weep for this family; the part of me that values public safety in today's world of terrorism feels like the air marshall might have made the right decision.
     
  3. 50960

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    Of course he/she did.... How could anyone doubt that??
     
  4. Poety

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    I'm with psisci on this one - I still have that left over fear resonating everytime I get on a plane - and I admit, I look around and see whos on that plane with me. I'm only human afterall. But if I saw some guy running up and down yelling they had a bomb, I would want him shot dead too - and I'd have a tough time believing it was a mental illness in that situation.

    Whats a real shame is that his psychiatrist didn't have him better controlled. And why would his wife let him fly knowing he was off his meds? I mean thats not the smartest thing to do. Had it been my husband, I'd do all I can to keep him from stressful situations until he was back on his meds right?
     
  5. Anasazi23

    Anasazi23 Your Digital Ruler
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    I also agree that the air-marshal made the right decision. It's impossible to triage in that type of situation quicly enough to ensure safety of the passengers.
     
  6. Miklos

    Miklos Guest

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    I can't remember how many times a relative has begged me to help get their loved one involuntarily admitted and how many times, my attending has said no, because the person was not a clear danger to themselves or others.

    Way too often...
     
  7. Poety

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    I believe it Miklos, and an excellent example as to why this wife should have been like "no honey, no plane rides for you!" Now granted, not all of us have this insight, but I'm assuming if she was yelling that he's mentally ill - she had some idea of just how out of hand he can get. And ofcourse, its not to blame her, as we all know, the sad case is that loved ones end up being responsible (not directly, but you catch my drift) for the mentally ill - its a lose lose all the way around :(
     
  8. Miklos

    Miklos Guest

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    Agreed. I just know how difficult it can be even when the relatives have insight. According to the media reports, they were travelling from Ecuador when this took place. It is possible that she felt that he could only get the help he needed once he returned to Florida.

    CNN reported this:


     
  9. Anasazi23

    Anasazi23 Your Digital Ruler
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    I know how you feel, but involuntarily commiting someone is a big deal. You're essentially taking away a good portion of their civil rights. People don't respond positively to this, and in the age of defensive medicine, this option must be weighed carefully for "on the fence" cases.

    Unfortunately, we're often in a "damned if you do - damned if you don't" scenario.
     
  10. Miklos

    Miklos Guest

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    There's no need to persuade me, but I'm sure that folks outside of psychiatry who happen upon this thread will appreciate your comment.

    I was only pointing trying to point out that real world problems are exactly that.
     
  11. psychedoc2b

    psychedoc2b Senior Member
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    I agree that the air marshal should have shot the individual but not to kill. There are many other incidents in which the police shoot to kill because they don't have appropriate training to deal with the mentally ill. They just assume the worst and only realize afterwards that the individual who was killed was mentally ill. There should be more training for the police to deal with people with mental illness. It has been shown that people with mental illness who don't take their medication have a tendency to act erratically. Some of them have a suicide wish and use the police to grant them this. If there were more public awareness about mental illness, this situation could have been avoided. I hope that a constructive response will arise from this situation.

    Mental illness, such as bipolar illness, should be treated as a disease in which medication has to be taken. It is always compared to diabetes in which the afflicted have to take insulin. It is very sad to read about individuals with mental illness who stop taking their medication then threaten or harm others. Half of the battle is accepting that one is ill and the other battle is to take one's medication. My hope is that there will be more public education about the importance of taking medication for a mental illness. It is not a character flaw to have mental illness. It is a condition that needs to be addressed. The stigma of having a mental illness may be partially responsible for individuals who do not want to take their medications for their mental illness. If there were more acceptance for people with mental illness by the public, then it would be less problematic for these individuals to acknowledge their illness and take their medications. I have met too many patients who don't want to be known as a "kook" or a "looney". They just want to be like everybody else. They want to be accepted by others. They don't want to acknowledge their illness because it is seen as a character flaw, not a disease. Thus, increased public awareness about mental illness being a disease which there is no cure yet might change the attitude towards the mentally ill. In response to this, my hope is that the mentally ill won't feel stigmatized, realize the nature of their illness, and take their medications.

    psychedoc2b
     
  12. grunermann

    grunermann Senior Member
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    What worries me is that the public will stand behind the marshall unquestionably. I agree that this is a sad situation. I just wish it would lead to the obvious need of better public assistance instead of legislation discriminating against the mentally ill.

     
  13. toofache32

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    That may be true, but in this emergency-type scenario, there is no time for the cops to take a med/psych history from the "patient."
     
  14. Poety

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    From what I heard, he was shot when reaching into his backpack - for that, I'd want someone to be shot dead too. What if he HADN'T been bipolar, and really did have a bomb? We unfortunately live in different times than we did pre-911, and we can't take the chances we used to be able to take - just look at what happened in London and the hotel bombing - this stuff is quite real.

    But I agree that there needs to be more public awareness about mental illness in general, however I don't think public awareness could have changed the outcome of the situation. This is an unfortunate event that came about because a patient became psychotic in an environment that cannot tolerate psychotic outbreaks due to the current state of affairs.
     
  15. MoosePilot

    MoosePilot Y Bombardier
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    Shoot much? Imagine yourself looking down the sights at a man who is running up and down an airplane yelling that he has a bomb. He then runs towards you and reaches into his bag, where he may have a bomb trigger. The bomb may go off at any second, killing hundreds, including you. He's not stopping, even though you identified yourself as a federal agent and directed him to get on the ground.

    Where would you shoot him? The leg? When the bomb will be set off by his hand? The hand? Ever shot a hand sized target on a moving object with adrenaline reaction already starting to give you the shakes?

    Easy to be an armchair quarterback, but the marshal is blameless.
     
  16. psychedoc2b

    psychedoc2b Senior Member
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    This is exactly what I mean. People just assume the worst and don't take in account that there could be other reasons for an individual to threaten harm even though they did not mean it.

    Just think, he went through the security checkpoint and the baggage checkpoint. Are you telling me that security is lax and allowed to let a bomb go through the checkpoint?

    You don't need to answer because I know you are just trying to cause trouble.

    I know some people don't think about situations carefully enough and just let fear rule their actions.

    Also, his wife was right behind him stating he was mentally ill and needed his medications.

    I really would like to see a bomb that cannot be detected by the screeners and yet get through their screening.

    psychedoc2b
     
  17. Poety

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    psychdoc, I'm not so sure toofache is trying to cause trouble here - I'm one of the regulars and I agree with his/her assessment too - I think that just because I'm a psychiatrist doesn't mean I can't look at the situation without psych glasses on - I mean, this guy was threatening the lives of people in a hostile manner on a plane, and you're not talking about someone who is going to say "oh hey, how long have you been off your meds?" these men are TRAINED to protect us - so I agree with Moose - the marshall IS blameless.
     
  18. psychedoc2b

    psychedoc2b Senior Member
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    I've seen some of his postings poety. So, I do have some reason to say this. Everybody has a right to their opinion however. I think both of you don't trust the abilities of a screener and the checkpoint security. Better off not taking a plane then. You never know what might get through that checkpoint. We all have to be paranoid now and realize a "bomb" went through the security checkpoint!!

    I"m shaking all over now because I have so much fear now about people bringing bombs on the airplanes.

    Good luck!
    psychedoc2b
     
  19. Poety

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    To the bold comment above: who the heck do you think you are telling people not to take a plane?

    Wow psychdoc, your response infers a lot of hostility and sarcasm. :rolleyes: People will disagree with you, and if they do so in an adult manner - why would you be so immature about the whole thing? :p

    As for toofache - I was just trying to say I wasn't convinced he was trying to cause problems - my goodness, relax a bit - and people have a right to doubt the security checkpoint, isn't that their perogative anyway? Who are you to be the grand marshall on the matter and chime in with your snide remarks? :thumbdown: Were you there when he went through the checkpoint? Did you already do your own analysis of just how good the checkpoint is? :rolleyes:

    This discussion was going well - until here again, as I eluded to in my thread "pathology of the forums" its going right down hill.

    SAZI WATCH THIS ONE - ITS GUNNA BE ANOTHER RIDE :laugh:

    edit: another one bites the ignore button! WOO HOOO leave me alone Sazi, I love my ignore ok? :love: :love:
     
  20. psychedoc2b

    psychedoc2b Senior Member
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    Geez! Like I said, everybody has a right to their own opinion.

    Get a life!!
    psychedoc2b
     
  21. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    This is in the news because it happened in an airport. (I keep hearing different versions--i.e. he was on a plane acting strangely, he wasn't on a plane, etc. etc...)

    It happens probably every day somewhere in one of our major cities.
    A mentally ill or intoxicated individual approaches police in a "threatening manner", or resists arrest, or is in the wrong place at the wrong time and the cop feels the need to use deadly force to bring someone down.
    It's a tragic and no-win situation for everyone. Don't know what more can be said.
     
  22. Poety

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    Well said OPD and very true, no one is winning on this one. :(
     
  23. Anasazi23

    Anasazi23 Your Digital Ruler
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    Sheesh, I leave the computer for a couple hours and look what happens.

    I think that everyone can agree on certain components of this event. That is, a patient who had an exacerbation of his illness was shot and killed, through no fault of the air marshall performing his duties.

    As OPD says, this is a tragic happening, but one that thankfully happens relatively infrequently. Every few months we have someone jumping the White House fence only to be taken into custody seconds later - usually unharmed. I'm willing to bet that a large porportion of these folks are mentall ill in some way. Yet they aren't killed. Our police forces do a great job this way. Granted it's a long run from the fence to the White House interior - a much different scenario than an enclosed space with crowds of people.

    In my experience here in a major city, I find that the police do a pretty good job of knowing who's mentally ill and treating them as such, instead of people just looking to cause criminal mischief. When it comes to scenarios such as this latest one, however, it probably is better to err on the side of caution, lest many more people get hurt.

    Shooting this patient in the leg or some other place to incapacitate him would have been the best case scenario, but as mentioned, is very difficult if not impossible under those circumstances. Incapacitating the person in question may not have prevented a bomb from exploding, depending on the circumstances.

    Again, it was an tragic circumstance that was probably unavoidable - I think we can mostly agree on that.
     
  24. toofache32

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    ...except me, right?

    As for stirring up trouble, I don't understand why I was singled out here. I'm not sure which of my other posts you're referring to, but I would be interested to know. I've never been good at keeping my opinion to myself. But neither does anyone else around here.

    Here's my question: How should Air Marshals determine if a passenger has a mental illness? And if there is a mental illness, does this mean they don't have a bomb? I doubt they did a MMSE.

    In one sense, mental illness is irrelevant here, because if you act out this type of threat (mental illness or not) you're going down.
     
  25. MoosePilot

    MoosePilot Y Bombardier
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  26. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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  27. MoosePilot

    MoosePilot Y Bombardier
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    It's definitely a chain of events. There *might* be explosives that made it through the baggage handlers, suddenly there's a man claiming to have a bomb, and those marshals had to make a split second decision whether the two things were connected. I'm glad I'm not them.
     
  28. psychedoc2b

    psychedoc2b Senior Member
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    Interesting. To me, it sounds like a coverup and sensationalism. Have they caught the man in this incident? I think the press is trying to make it sound as if it were allright to kill a man because of someone else's actions. Does this mean that there is no justice for those who act erratically even though their threats are hollow? We can't assume that ALL screeners don't do their jobs. This could be a case of profiling and racism. What if the man with bipolar had been caucasian and had a good command of english? Would this have happened? Don't know. What if a child had said they had a bomb? Would the air marshal have shot the child? The whole incident is sad indeed. I am planning on taking a plane this weekend. I am not afraid of taking the plane but hope that noone including me does not have a breakdown and flip out because of too much stress or stimulation or fear of others. I hope that this incident brings public awareness to mental illness. I am not trying to offend anybody per se. I just want to have people realize that there is more to the story than what is being represented by the media.

    Good night!
    psychedoc2b
     
  29. Miklos

    Miklos Guest

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    Please refrain from feeding the troll. Thanks.
     
  30. Poety

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    Whos the troll Miklos?
     
  31. RustNeverSleeps

    RustNeverSleeps Walker, Texas Ranger
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    A couple things...
    1. Maybe I'm missing your point, but how exactly would increased public awareness/tolerance have prevented this situation? If you mean that in such a scenario, a person would be more likely to take his medication and get the help he needs, thus preventing him from even being in the situation to begin with, I agree with you. However, if you mean that in a society more understanding of people with mental illnesses, the marshal would not have had to shoot the man, then I highly disagree. Under those conditions, any terrorist with half a brain would realize that all he would have to do is act crazy and that would give him enough time to detonate the explosives. (Sorry in advance if I misunderstood you.)

    2. I believe that the marshals are essentially under instructions to "shoot to kill." What I have heard (I don't know for sure if this is true or not, but it makes sense), is that they are supposed to shoot a person like this in the head. If they shoot just to injure (ex. in the leg or the shoulder), the person may still be able to detonate the device. This a sad case of having to put the good of the many before the good of the individual. Maybe some good can come out of this situation in that it can be a reminder (albeit a tragic one) for people with mental illness and their familes on the importance of getting and following through with psychiatric treatment. It might be too optimistic to think that, though. :(
     
  32. toofache32

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    I agree that it was a shame, but you're going pretty far out of your way to reason that this was preventable somehow.

    I still don't have an answer to this: Even if the Air Marshals knew he suffered from a mental illness, how does that change the fact that he threatened them with a bomb? And how would it change the management? He could still have a bomb. I would argue that people that do have bombs are not completely mentally fit.
     
  33. Poety

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    I'm with you toofache - 100%, I had that post on ignroe but I can see it if someone replies?! :p Anyway - yeah, thats so far out on how it was preventable - its asinine. :rolleyes:
     
  34. psychedoc2b

    psychedoc2b Senior Member
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    From what I've recently read about the situation, the person who was killed never said the the word "bomb". The passengers who were on the airplane confirm this. If this were true, I stand behind my statement.

    http://www.orlandosentinel.com/news/local/orange/orl-planefolo0905dec09,0,3421926.story?coll=orl-home-headlines
    psychedoc2b
     
  35. toofache32

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    Here's a few more quotes from that article. I rest my case:

    "The marshals say Alpizar yelled that he had a bomb and would use it. He walked toward them, they backed up, he started to put his hands in his backpack, and they fired. Alpizar was hit by multiple shots fired by both officers."

    "But spokesman Dave Adams said if the marshals aboard Flight 924 had known of Alpizar's illness, it likely wouldn't have changed things."
     
  36. toofache32

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    Once again....If you suffer from mental illness, does that mean your bomb threats should not be taken seriously?

    No answers here?
     
  37. Poety

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    Mental illness or NOT, in this day and age you have to take it seriously - its better to protect the welfare of 100+ for the sake of one, regardless of how delusional they are.

    Perhaps the next argument should be how to protect the mentally ill from getting into these situations in the first place? That was my idea from the beginning- I really do believe more needs to be done to help them NOT get ona plane when they're not medicated, I mean you can always delay flying until the person is more stable. I'm sure any psychiatrist would try to help stabalize a patient as well - and wouldn't recommend flying back to the US when they know they have the tendency to become frankly psychotic. As Sazi said, all the probing that occurs at the airport alone is enough to throw someone with the tendency into a paranoid delusion.
     
  38. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    That's some of what I was thinking--like someone should have made sure this poor guy was travelling with some prns. International travel is a definite risk factor for decompensation--sad to think it could have been prevented if he or his wife had had a couple of mg of Ativan in their carryon...
     
  39. Hurricane

    Hurricane Senior Member
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    There was an interesting essay on salon.com about the incident, written by a pilot. From the article:

    the rest is here
     
  40. Anasazi23

    Anasazi23 Your Digital Ruler
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    Powerful words.

    I agree with him.
     
  41. toofache32

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    How is his mental illness even relevant here? You make a threat...you're going down. Seems like an open-and-shut case to me.
     
  42. Poety

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    I think first its because you're in the psych forum toofache :) so OFCOURSE its relevant HERE!!! :laugh: On a serious note though - I see where you are coming from and thats why I think we need to turn the page, learn from this and see how we can protect our patients from being exposed to this again.

    Now (as is the case always) in hindsight, we have the experience to see how risky a decompensation can be when it occurs at an inappropriate place. As psychs, I think this can be a great learning experience for us. We can consider asking patients about travel plans, about whereabouts and what they are up to "casually" not probing like - but just to make sure that with our psychotic patients or those that are non-compliant, we can maybe keep in closer touch with the family to counsel them on not allowing them to be exposed to crisis provoking situations.

    Just my thoughts on this whole thing anyone else?
     
  43. Anasazi23

    Anasazi23 Your Digital Ruler
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    This whole ordeal came up today in rounds.

    We're sending a lady back to Puerto Rico (taxpayers foot the airline bill :thumbdown: ) and she's a little....loose at times.

    At first we sort of chuckled at the concept of some poor soul having to sit next to her for hours on the plane. But then the conversation turned more serious, and eventually turned to the notion of providing PRNs for the plane ride.

    Of course, it depends on the clinical presentation of each individual patient, but we opted to go with something the psychiatrists thought would work. Hopefully it'll be ok for her. :scared:
     
  44. Poety

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    :scared: :scared: Now are we going to have to worry about endangering others as psychiatrists by allowing patients to fly if we know they are psychotic? You konw once lawyers get wind of something like this they will find something right? :rolleyes: :mad: So, how much responsibility do we really have Sazi? I mean for psychotic patients that we know are gong to be put in stressful situations - what ramifications (legally) can happen if we make a mistake? And how can we protect ourselves from suits in this area? Would we even be liable?
     
  45. Anasazi23

    Anasazi23 Your Digital Ruler
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    We were somewhat comforted by the fact that a family member will be with the patient when she goes. A good, solid discharge plan (with stellar documentation) is worth it in these types of cases, even if it prolongs your length of stay.
    Yes, you do have to worry about endangering others when you release them. There have been lawsuits against hospitals that attempted to show negligence on the part of the psychiatrist by premature release...even if the managed care company refuses to pay for continued stay.

    Remember, anyone can bring a case. Whether or not the suit is successful is an entirely different matter. Luckily, psychiatry is one of the least likely specialties to incur malpractice claims. And, suits brought against psychiatrists are largely unsuccessful.
    As such, our malpractice is some of the lowest rates of any specialty. Another benefit to being in psychiatry.

    Documentation. :)
     
  46. Poety

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    Thanks Sazi :)
     
  47. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    They are currently discussing this issue on NPR's Talk of the Nation.
    If you missed it, perhaps you can download a podcast...
     
  48. Poety

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    I don't have an ipod, when can I catch it on radio?
     
  49. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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  50. Poety

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    thank you! now get back there and comment on that psychodynamic thread :p
     

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