Views vary over man’s treatment: An in-depth look at the Western State patient

By one view, César Augusto Chumil is a violent man whose mental illness is of enormous complexity.
Published: July 10, 2008

By one view, César Augusto Chumil is a violent man whose mental illness is of enormous complexity.
Much of his adult life has been spent in restraints or some version of specialized seclusion.
“In the last 22 years, we’ve had 18,000 patients admitted and discharged except for one, very unique individual,” Western State Hospital administrator Susan Frushour told the hospital’s Human Rights Committee in January.
Chumil has assaulted all but five of 28 aides working on the Western State ward where he lives. At one time, he averaged 300 assaults a year against staff and 100 more against patients, Frushour testified.
Another view portrays Chumil, 57, as an all-but-forgotten human remnant of a failed system of care.
In this view, Chumil’s lawyers describe him as an isolated man whose locked containment suite more resembles a dog kennel than a privilege-laden retreat.
This morning in Fredericksburg, the state Human Rights Committee will hold a hearing to decide whether to uphold the Staunton hospital committee’s findings that key elements of Chumil’s care violate basic laws affecting hospitalized mental-health patients.
Chumil, his lawyers say, has been shunted aside for the convenience of administrators who regarded him as incurable.
Chumil’s telephone, television and private bathroom are window dressing that disguise the illegality of his seclusion, his lawyers argue.
The length of his near isolation — 25 years — at Western State and at other state mental facilities appears to be unmatched by any other modern-day patient in the state’s mental-health system, his advocates say.
The conflict over Chumil remains unresolved after more than two decades.
His seclusion was targeted in a wide-ranging federal investigation of Western State in 1999 that cited a longstanding, indefensible reliance on restraints and confinement, staff shortages and other endemic problems there.
“Our argument is that the hospital is in violation of multiple federal and state laws that are designed to protect the mentally ill,” said Alex R. Gulotta, executive director of the Charlottesville-based Legal Aid Justice Center.
Gulotta and Charlottesville lawyer Nathan J.D. Veldhuis, who represent Chumil and his family, have said they will take his case as far as the U.S. Supreme Court if necessary.
Hundreds of pages of documents made available to the Richmond Times-Dispatch by Chumil’s family and lawyers chart decades of confinement, multiple drug regimens that have largely failed, scores of assaults against caregivers, and long-term objectives that seem to go no further than lessening Chumil’s persistent dangerousness.
The state Department of Mental Health, Mental Retardation and Substance Abuse Services has refused to make public the documents in the case because of privacy concerns.
In one undated document written by Western State’s current director, Jack Barber, Chumil is described as a patient whose demands overwhelmed the hospital’s staff.
“The focus of the staff is primarily on Mr. Chumil, around whom the entire operation is revolving. It is not clear to me how much more of this can be tolerated without a very major issue developing, with a loss of control by the staff, a severe injury, or a massive loss of staff,” the memo reads.
It then lays out a scenario of decreased attention to Chumil by establishing a plan that is “sufficiently restrictive that it restores control of the ward to the staff.”
“I think when there is a degree of crisis which has been building and has now fully arrived, ‘cutting our losses’ is simply all we can do,” Barber wrote.
Gulotta said the memo appears to set up Chumil’s isolation from the rest of the hospital’s population, ending a pattern of shackling or temporarily secluding him for his erratic behaviors. Instead, the lawyers say, the decision was to house Chumil in a three-unit suite.
Called a no-contact locked containment suite by the hospital, it includes a living area, bathroom and small patio that is separated from an open courtyard by a tall, chain-link fence.
Gulotta and Veldhuis and their experts argue that Chumil subsequently became captive to a failed system that recycles his harsh experiences and feeds his paranoia.
Medical records reveal a man who has overcome colon cancer, whose teeth all have been extracted for medical reasons, and whose potential for violence means caregivers never turn their backs on him.
Multiple documents describe Chumil’s English as sufficient only to address simple tasks and needs. Yet no treating physicians speak his native Spanish.
In April, Chumil’s sister described for the hospital’s Human Rights Committee the impact of years of isolation and limited human contact.
For the length of Chumil’s confinement, she said, family members have visited him monthly, making the three-hour trip from the Washington suburbs.
And she said that despite his long record of assaults, he has been allowed to leave the hospital grounds unrestrained on scores of occasions with his mother and siblings.
“I can see the difference from all these years that he’s getting depressed, more upset,” Chumil’s sister testified. “Sometimes he tells me that he wants to die because it’s no way to be alive in that room.”
Aides testified at multiple hospital Human Rights Committee hearings this year that Chumil piles his room with trash, defecates on the floor and has flooded the room by ripping off sprinkler heads.
When Chumil leaves the suite, he can attack with no warning.
Testimony showed he slugged a nurse after offering to shake hands. He said later that he interpreted the woman’s smile as a mockery of him. Angered about a damaged DVD, he broke a nurse’s jaw. She still compassionately reaches out to his needs, according to testimony in the case.
Chumil’s sister explained his conduct: “It is the way he protests that he’s alone. He wants to call attention, because he’s very tired to be by himself and because he’s sad, and because he doesn’t want to be there is why he do that.”
Chumil came to Virginia from his native Guatemala in 1980, joining his family. Like his late father, he was a shoemaker. ¶
He first was hospitalized for psychiatric problems in Guatemala in 1978. He had been an honors student but quit school. He burned his books, wandered aimlessly, and, according to medical records, stabbed himself in the chest when he was 17.
Some of his mental-health problems originated from a head wound when he was hit by a rock at age 7. In November 1981, he began having hallucinations and terrible nightmares that made him scream in his sleep. He first entered Western State in December 1981; readmitted in February 1986, he has remained there since. He has been diagnosed with multiple forms of schizophrenia, anti-social personality disorder and severe paranoia.
In January this year, a Richmond psychiatrist urged that Chumil be removed from his “present, punitive-based treatment environment” where his reputation for violence has superseded the ability of caregivers to treat him.
Gulotta said Chumil’s family wants him close to home in Northern Virginia, removed from an environment overloaded with a difficult past.
“The hope [is] that he will not die in a place that is a locked kennel.”
It is a place where nurses and aides for years and years have peered through a window every 15 minutes to monitor Chumil’s condition, where doctors have signed orders every day at noon to continue his seclusion, and where other patients once threw rocks at the toothless Chumil when he ventured onto his 134-square-foot patio with the chain-link fence.
It is a place, according to the testimony of one hospital official, that is not really a place of seclusion after all. The locked, limited-contact suite “is actually a safe port in a stormy sea,” she said.
Bill McKelway is a staff writer for the Richmond Times-Dispatch.