Only when he was arrested and thrown into jail for demanding help was he declared a danger to himself. His "treatment" consisted of a strip search and a jail cell.
But that's only the beginning of the insanity.
The Emergency Medical Treatment and Active Labor Act was passed in 1986 to prevent hospitals from triaging out, or dumping, difficult or impoverished emergency room patients like Garza, a former business owner, cabdriver, and bookkeeper who has been on Social Security disability since 1995. EMTALA mandates that any patient who goes to an ER must be given an "appropriate medical screening examination." After he got out of jail, Garza sued the city, SF General, Lewis, and other city employees, contending they violated his rights under the act. He could not afford a lawyer, so he represented himself.
In one of the strangest twists of this twisted tale, Garza finally made it into the inner sanctum of SF General's PES as a result of his suit against the city. But as with his night in jail, the circumstances of his psychiatric care were not what he was expecting.
While Garza was giving a deposition at the City Attorney's Office in March 2003, his behavior prompted staffers to call in the authorities. According to an official report of the incident, Garza made suicidal remarks like "I have no desire to live." He also allegedly said that he "needed/wanted bullets and a gun." These statements are not present in the 168-page deposition. Garza did acknowledge to the Guardian that he became upset that day, especially when questioned about his experiences at SF General and the suicide of his lover, but he claimed that deputy city attorney Burrell "set him up" and that the calls to the mobile crisis unit and police were part of "an attempt at witness intimidation." Whatever the reason for the calls, Garza was detained for a 5150, a procedure under which subjects are involuntarily committed for up to 72 hours. The City Attorney's Office had no comment on the issue.
Amazingly, police took Garza to the same PES department at SF General where the saga began. This time, though, he made it past the lobby and received a medical screening exam, marked by a report and other SF General paperwork. The mere fact of this report's existence, Garza claims, proves that he did not receive proper care when he went to the hospital voluntarily in 2001. Deputy city attorney Burrell informed Garza by letter that the only record the hospital could produce from his 2001 visit was a triage report filled out by Lewis, the nurse. EMTALA does not permit triage of a patient without a subsequent medical screening examination.
However, in pretrial motions, the city argued that Lewis treated Garza like any other would-be patient and thus complied with the law: "EMTALA requires hospitals to provide a screening examination that is comparable to that offered to other patients with similar symptoms." In other words, Garza's treatment may have been poor, but so was everyone else's, so he had no case, the city contended. Judge Phyllis J. Hamilton agreed and tossed out the suit.
Perhaps the strongest proof of Garza's "adjustment disorder" and need for psychiatric care, ironically, is the fact that he continued to press his case even after his lawsuit was tossed out, taking on a health care system that could make anyone feel unhinged. For the past six years, he says, he has badgered "10 to 15" local, state, and federal agencies, as well as government officials like Sup. Bevan Dufty and aides to House Speaker Nancy Pelosi (DSan Francisco). In the process, he has compiled an encyclopedic collection of letters, petitions, records, and even audiotapes of phone conversations.
"There isn't a single agency that's in charge of anything," Garza said of his dealings with the health care bureaucracy. "You're parsed.