A stabbing rampage at a local mall last week confounded everyone because of its senselessness and sheer brutality. How could something like this happen? Then we learned the suspect, Arthur DaRosa, had actually sought help at Morton Hospital in Taunton for depression and psychotic delusions and was released early in the morning on the day of attack. His family spoke out, charging the health care system failed him. 

One of the big questions is whether a system that requires a third party contractor do a mental health evaluation for a MassHealth patient actually contributed to DaRosa's untimely release. Now the state is investigating whether the hospital made any mistakes in the way they handled this case. 

Forensic Psychologist Robert Mendoza and President and CEO of Massachusetts Association For Mental Health, Danna Mauch, joined Adam on Monday night to discuss.

There is currently a two tiered system in Massachusetts. If you have private insurance and you seek mental health care, you are treated by the hospital staff. If you have MassHealth, you are treated by a third party contractor. Mauch spoke about the MassHealth services and benefits, including crisis services. "Crisis services includes ... assessment, it includes in some cases diagnostics... and then a determination about what would meet the immediate needs of that patient," she said. 

Often times, at smaller hospitals, there isn't enough staff to do psychiatric assessments. Mendoza mentioned the differences between large metropolitan hospitals and smaller community hospitals. In a large hospital, he said, "if someone comes in they have their person within the hospital evaluate that individual, whether or not they have medicaid." If the person has Medicaid, they use the emergency services team for assistance in providing access to care. But they do not rely on them to give the primary assessment. The hospital uses their own attending and training staff for that assessment, and does not rely on a third party contractor. However, at a smaller regional hospital, they might not have access to that. 

Mauch agreed that the hospitals may not have psychiatric staff to do the assessments. She said that "some private insurers do elect to contract with the emergency services team to provide access to a broader array of services." If Mauch's loved one were in this position, she said she would want them to have access to a broad array of services. 

Mortan Hospital released a statement arguing that this system with Mass Health is part of the problem. It reads:

 "... the current policy mandating that the evaluation process must be carried out by a third party state contractor is misguided." 

This case raises an enormous number of red flags, according to Mendoza. He said that while we don't know what happened from the moment DaRosa arrived at the emergency department, we would want to know what chain of events occurred. "No matter what the emergency services team said, an emergency room physician would have to have agreed with the disposition," he said. "Somewhere along the way, the hospital had to have been in agreement with the decision that was made."

There are still  many unknowns in this case. "We don't know whether the clinician felt they had resolved the symptoms and therefore discharged the individual based on the fact that perhaps they received medication and after a number of hours were no longer expressing suicidal thoughts or expressing some of the other delusional statements," said Mauch. She said it is difficult to have an opinion about what happened with DaRosa. 

However, we may soon get answers as to what went wrong in the system. Mendoza said that there are parallel investigations in this case, a criminal investigation into the loss of life, and the Department of Mental Health is also looking into the events. Mauch added that the Department of Health is also investigating based on its authority as the licensing agency.