from THE NEW YORK TIMES, October xx, 1996, pp, B1, B4
reprint granted on Dec. xx, 1996 by the New York Times as per
229 West 43d Street
New York, NY
Committed Against His Will
For Medical Student, a 5-Week
By ELISABETH ROSENTHAL
Leonard Drey got high marks as a senior medical student at Coney Island
Hospital, treating patients with heart disease and AIDS.
September, he was back at Coney Island, this time locked in a psychiatric ward,
after psychiatrists from his medical school declared him dangerous and had him
Mr. Drey, who suffers from manic depressive illness, spent
five weeks in the hospital against his will, despite protests from his lawyers
and psychiatrists that he had harmed no one and did not meet the legal standard
for commitment. Wearing shoes whose laces had been confiscated, he passed
endless dull days watching television, reading old medical texts and working the
pay phone, calling doctors, lawyers, friends, reporters, anyone who might help
him get out.
While state law guarantees patients hospitalized
involuntarily an expedited hearing, Mr. Drey's court date was delayed for more
than a month, first because of scheduling problems and then because the lawyer
for the hospital was ill.
Last week, bowing to the opinion of four
psychiatrists, a Brooklyn judge ordered him released. Mr. Drey was left with a
$39,000 hospital bill. His ordeal left questions about whether the commitment
was justified and whether the legal system to safeguard the rights of such
patients is adequate.
In commitment papers and medical records, doctors
from the State University Health Science center at Brooklyn, where Mr. Drey was
a student, and at Coney Island Hospital contended that he was "guarded, hostile
and uncooperative" and accused him of threatening, erratic and possibIy
delusional behavior. But to support their contention that he possessed "a real
and present threat of substantial harm to himself or others," the legal standard
required for commitment, they rely mostly on one example: a minor altercation
with a fellow medical student that involved name-calling and possibly a
While Mr. Drey acknowledged that he was exhibiting some symptoms of
his manic depression last month, he insisted that he posed no danger to anyone
when medical school officials led him from an infectious disease course and
forced him to undergo a psychiatric evaluation.
"There was no medical or
legal reason for hospitalizing me," he said. "If they had a problem with my
behavior, they should have called me to discuss their concerns and then , maybe,
suspended me with instructions to see my psychiatrist before coming
The law grants any doctor broad power to order dangerous patients
with mental illness committed after a brief examination, to protect society and
patients themselves from harm. That power, however, is supposed to be balanced
by legal safeguards to prevent mistakes and abuse. But Mr. Drey's case
illustrates the potential pitfalls in this balancing act. While a patient can be
committed quickly, reversing the process can be far more difficult. Hearings can
be delayed for weeks, and the outcome often depends as much on where the case is
heard as on the patient's mental condition. And while Mr. Drey, the 37-year-old
son of a prominent Midwestern family, had the knowledge and money to hire
psychiatrists to win his release, many patients have no such support.
lost five weeks of his life and maybe his medical degree," said Michael Lander,
a legal scholar with a history of schizophrenia. "What happens to someone who
can't marshal those resources? Many commitment hearings are an
A History of
Mr. Drey was diagnosed with mental illness 17
years ago and has been hospitalized six times before, twice involuntarily.
Despite this, he has two degrees and has worked as a journalist and scientific
researcher. He usually received good grades in medical school, but acknowledged
that he had several run-ins with the administration, and just before his
commitment, had threatened the dean with a lawsuit over a course
Friends and colleagues described him as thoughtful and extremely
bright, if headstrong, and said he often chafed at the boot-camp mentality of
medical school. "He kept challenging superiors, which is counterproductive
here," said Daniel Soutern, a fellow student and friend. "I counseled him to toe
The path this led to hospitalization began in the early summer
when, with the consent of his psychiatrists, Mr. Drey tapered off his
psychiatric medicines because they made him feel dull and to see how he would be
In July, he spent a month working at Coney Island Hospital,
where he earned high praise. "He was excellent with patients and with
colleagues," said a doctor who supervised him, speaking on condition of
Dr. John Knesevich, a psychiatrist who had treated Mr. Drey
when both lived in St. Louis, saw him at the end of August and felt he was
basically well. "It didn't even cross my mind that he needed hospitalization,
involuntary or otherwise", he said. "I didn't even think he needed
Dr. Knesevich did say, however, that he was concerned because
his patient seemed "mildly euphoric" which he took as a warning that his manic
depression might he reemerging. During the next 10 days, Mr. Drey said, he
became more "high" and confrontational. He was' thrown out of a restaurant for
pestering the chef and another for arguing with a waiter, and had two arguments
with police officers, incidents that were out of character, friends
"Leonard was definitely racing, but he was also coherent and he
knew at some level he had to stop this process,", said a friend who insisted on
anonymity. "It would have been nice if there was a better mechanism than
confronting him and throwing him in the hospital.
Then came the argument
with another student. They traded insults and she complained to school
administrators about Mr. Drey. School officials and he had pushed her, though he
(The student, Sarah Egan, referred all question to the medical
school. Officials at the medical school as well as Coney Island Hospital
defended their treatment but 'refused to comment on the case, citing
On Sept. 10, four days later, Mr. Drey was asked
to go to a dean's office, where school administrators and a psychiatrist were
waiting. After a 20- minute evaluation, he was escorted by two security guards
to Kings County Hospital, an affiliate of the medical school. He was transferred
Island, another public hospital, the next day.
papers and admission notes asserted that Mr. Drey was dangerous, but shed little
light on how the doctors came to that conclusion, other than referring to the
"alleged" assault which is never described in detail.
proceedings involve serious acts of violence or severely distorted thinking; for
instance trying to throw a child out a window in the belief that he is possessed
by the Devil.
"This case falls far short of the commitment standard,"
said Dennis Feld, a principal lawyer for Mental Hygiene Legal Services. "The
lesson here is if you have a history of mental illness, never raise your voice
and never push someone."
While Mr. Drey's own psychiatrists were
reluctant to pass judgment on the initial commitment, since they did not see him
at the time, Dr. Lawson Siegel, an independent court-appointed psychiatrist,
noted that the pushing incident had never been confirmed and that the victim was
apparently not injured. "This would tend to argue that even when he was most
ill, he was not a continuing danger," Dr. Siegel said.
Mr. Drey's lawyers
also criticized the medical school for using its own doctors to evaluate him,
rather than seeking an independent judgment, and questioned whether the school
was in part motivated by desire to get rid of a troublesome student.
Mr. Drey had worked in a law firm or a restaurant, they said, he would more
likely have been dismissed or told to stay away from work until he sought
Kris Glen, the dean of the City University of New York Law
School, said the case might reflect a common tension in commitment.
doctors may be well-meaning," she said. "They think here's this student who is
very smart and sick, and we'll just commit him and he'll get better and come
back to school. But the law imposes a different burden."
Odds Are Against Getting Out
Mr. Drey filed for a
court hearing to gain his release at 11:15 A.M. on Wednesday, Sept. 11, 15
minutes after he got official notice that he was being held.
were against his success. While many counties rotate judges for commitment
hearings, a vast majority of such cases in Brooklyn are heard by one
judge, Maxine Duberstein, who rarely forces hospitals to let patients go.
Statewide, judges release 30 percent of patients at hearings, while in Brooklyn,
the figure is just 2 percent, according to Mental Hygiene Legal
Moreover, the only person who usually testifies at such a
hearing is the psychiatrist who is holding the patient
"Statutes guarantee all sorts of legal protection, but in
practice it doesn't always happen," said Michael Perlin, a professor at New York
Law School. "And society winks at that, because we say that treatment is in the
best interest of the patient." He added that highly publicized cases of mentally
ill patients who commit violent acts have made judges extremely
For most of September, Mr. Drey was stuck in the dreary routine
of his fifth-floor hospital ward. It is a regimented place, with 6:30 blood
pressure measurements as wake-up calls, where meals are the high point of the
day and the principal activity is watching television, with men and women in
separate lounges. Injections and the threat of straitjackets (referred to as
"camisoles") are meted out to those who act up.
Mr. Drey's case did not
even make it onto the court calendar for almost two weeks. Commitment hearings
for patients at Coney Island Hospital are held only on Tuesdays, and the next
Tuesday was full. That first date, Sept. 24, was postponed to Oct. 1, so that a
psychiatrist whom Mr. Drey had hired could complete her evaluation.
mid-September, Mr. Drey had been put back on his medications. By late
September, Dr. Ruth Finch, the psychiatrist Mr. Drey hired to testify, was
prepared to say he did not need hospitalization. But Mr. Drey was angry and
uncooperative with the doctors at Coney Island, refusing even to let them get in
touch with his psychiatrist. They continued to insist he was seriously
At 9:30 A.M. on Oct. 1, Mr. Drey was bused under guard to State
Supreme Court in Brooklyn. Two hours later he was bused right back. Justice
Duberstein postponed the case for a week because Michael Forth, the lawyer for
Coney Island hospital, was ill and did not show up.
On Oct. 8, Mr. Drey
was again bused to the courthouse. By this time, three widely respected
psychiatrists had said that he did not belong in a hospital, including his
psychiatrist for the past three years, Dr. Jonathan W. Stewart, whose report
said that Mr. Drey had no history of violence and was conscientious about taking
medicines and keeping appointments. But Mr. Drey again left without a hearing.
The judge had decided that an independent psychiatrist should evaluate the
Mr. Forth, the lawyer for the hospital, said Mr. Drey bore part of
the blame for h is long hospital stay, since he refused to provide doctors with
information that might have led them to discharge him earlier. And Judge
Duberstein said, "It looks like a tremendous number of days, but it's not when
you consider the court schedule and all those doctors examining him."
Oct. 15, Dr. Siegel, the court-appointed psychiatrist, submitted a 15-page
report recommending release. Judge Duberstein agreed, though she added that she
thought Mr. Drey had been held with good reason. "You're going to get a break on
this," she said.
It did not feel like a break to Mr. Drey, who had missed
five weeks of his life and would have to apply to re-enter medical school, where
his future is uncertain. He headed out of the courthouse into a crisp fall day,
an endocrinology text in his hand. he walked across Adams Street to buy