Mental Illness Exacts Big Toll

Jan. 06--Next to the sliding glass door at the back of Cindy La Madrid's apartment is a small wooden placard that reads: "Hope."

She ran her fingers along the placard while talking about her late son, Louie Dominguez.

"Baby, if you wake up and you're still breathing, there's hope." That's what she would tell Louie before he died in February at age 26.

Since then, the 47-year-old Hazel Dell resident has found some solace spending time with her sister and attending City Harvest Church. Peace of mind is hard to come by, she said, considering her son struggled with multiple mental health issues that surfaced when he was a kid. Depression, bipolar disorder, schizophrenia, anxiety attacks and alcohol abuse, cited in medical records, rendered him chronically mentally ill.

Cindy watched her son rotate through jail beds and hospital beds before the seemingly endless cycle came to a fatal halt at Crown Centennial Park, just a few blocks from their apartment off Northeast Ninth Avenue.

A few days before his death, Louie left a note scrawled in pen on a piece of mail. It read: "Love you mom, really sorry about everything. Hope you do well. Tell Jess and the kids said love them. Love you." Although his script is hard to read, Cindy said he signed it "the bum," a monicker he gave himself.

On Feb. 5, a group of children playing along the bank of a drainage area at the edge of the park, also known as Dark Park, found Louie's body in the water. He was still in a sleeping bag, wearing two coats, as water sloshed over him.

"No one should have to die alone like that," Cindy said. "I have to live with that every day."

She even walked through the park in search of her son while he was missing, knowing it was a place he frequently went to clear his head.

"I should have walked more," she said. "I had a gut feeling."

Though the manner of death was ruled undetermined by the county's medical examiner office, Cindy said she believes her son ended his own life. "I think he lost the ability to want to be here."

The immediate cause of his death was from drowning and hypothermia, but he also overdosed on Xanax and Ambien, prescriptions used to treat anxiety and insomnia.

A rocky beginning

Louie grew up in Kingman, Ariz., with his mother, father and older sister. During his childhood, he had recalled being poor, getting in trouble at school and hearing his parents bicker. Medical records state that he was sexually abused at a young age.

After his parents divorced, they moved to Vancouver for some new scenery.

Medical records indicate his childhood traumas weren't addressed early on, and that he was hesitant to provide details about them to psychologists well into his 20s.

In June 2002, when Louie was 16, his father -- Louie Dominguez Sr. -- jumped to his death from the Interstate 205 bridge to state Highway 14 below. Following his death, Louie's mental health sharply declined.

"After my dad died, I started to hear voices, and I just started to get really weird," Louie said in a mental health evaluation. "I've had a lot of paranoid thoughts. I am kind of against everyone. I hear voices."

About five months later, he entered the court system for possessing alcohol, fourth-degree assault and third-degree malicious mischief.

Louie dropped out of high school, and earned his GED, thinking he would find work instead. But more often than not, Louie was unemployed. He had a hard time focusing, learning new things and sticking with projects, Cindy said.

The same went for his medical treatment. He was noted in his records as having skipped or canceled appointments for no reason. When he did attend, he spoke quietly and, at times, wouldn't respond to some questions or would abruptly end interviews.

His medical history is complicated by intentional opioid overuse, alcohol abuse and using multiple medications at once -- behaviors that resulted in drug-induced delirium.

Over the years, he continued facing charges of theft and underage drinking.

At one point, he traveled across the U.S., and he ended up in Chicago, where he was arrested and extradited to Clark County.

"I think he was just trying to run from pain," Cindy said.

According to a physician's progress notes on Louie, "He has been in multiple cities seeking medical help."

Local physicians noted that he was combative, often assaulting and cursing at people in the hospital. He often wouldn't stay still for examinations and could be seen pacing in his hospital room, the size of which he likened to a jail cell.

In 2010, Cindy became her son's legal guardian. Although the move revoked his right to consent or refuse medical treatment, Cindy said it didn't help her in the least.

"No one respected it at all," Cindy said.

At one point, Louie opposed the guardianship, according to court documents, and did not believe he needed a psychological evaluation. Notes from one of his exams at the Vancouver Clinic say: "He has a history of severe depression and other psychiatric problems. He is not aware of his diagnosis."

That was the problem, Cindy said: His disorders made him a poor advocate for his own health.

Despite the guardianship, she felt like she didn't have authority over his health. She said he had been admitted and discharged from hospitals on his own without a phone call to her. Once she was still in the waiting room when he was discharged and left on his own.

She surmises that her son would still be alive if people listened to her rather than taking her son's word regarding the state of his mental health.

"Louie doesn't think like we do," she said.

Daily anxiety episodes, accompanied by migraines, left him feeling short of breath, irritable and, at times, combative. On the night of May 5, 2012, Louie was standing in the middle of Mill Plain Boulevard. When a driver honked at him, Louie threw a knife at the driver, which hit the driver's-side window. He spit on arriving medical personnel, assaulted a paramedic and later, in the emergency room, two nurses. He was charged with three counts of third-degree assault.

He was jailed for about a month and told to take his medication as directed. Additionally, he was sent to Western State Hospital in Lakewood for 15 days of examination.

There he was determined to be competent to stand trial.

About a month later, he spit on another paramedic after assaulting a man at an apartment complex.

Struggling to the end

In the weeks before his death, Louie's struggles compounded. He went to the hospital several times in January, what his mother called cries for help.

Following a jail stay, he went for an evaluation at Columbia River Mental Health, where he was given Abilify and Xanax -- medications that he later admitted to abusing. (Xanax showed up in his autopsy.)

Four days later, on Jan. 11, he went to urgent care at the Vancouver Clinic because he was feeling tense and had chronic headaches. The medical records read, in bold, "patient is having significant anxiety issues." The physician diagnosed him with dysmythic disorder, otherwise known as chronic depression, and prescribed a new medication for anxiety.

Five days later, his mother found him on the floor of their apartment, bleeding from cuts on his forearms and crying hysterically. In an interview with The Columbian, Cindy drew 10 vertical lines in blue ink and a few across her wrist to show where her son had cut himself with a broken beer bottle.

This was the first time Louie admitted to her that he heard voices in his head and was drowning them out with drugs and alcohol. "I want to take pills and sleep forever," he told the responding police officer.

His blood alcohol level when he was admitted to the hospital was 0.149, and he tested positive for amphetamines.

He went to Legacy Salmon Creek Medical Center, where he was bandaged up and physicians addressed his feelings of agitation.

The next day, he had a psychotic episode. He fought with arriving police and told them, "I want to kill everyone," according to medical records. He stayed overnight at PeaceHealth Southwest Medical Center for treatment of psychosis, hallucinations and alcohol abuse.

In his discharge papers, depression, anxiety and agitation were ruled out, and he was determined to have no suicidal ideations.

A nurse at PeaceHealth requested that a mental health professional interview Louie. Toward the start of the interview, Louie said, "I don't know why I'm here. I mean, I have an affect disorder, but my mom just called the cops on me. I guess I was drinking, but the cops are out to get me. I wasn't trying to kill myself, and I'm not hearing voices." He said he wasn't a risk to others or himself.

When the mental health professional, Aaron Edwards, asked him about the cuts on his arm, Louie said: "I was having a mood disorder thing ... I hit a glass and it cut me up ... I'm not one of those people who hurts themselves." After the evaluation, Louie was sent to follow up with Columbia River Mental Health.

Three days later, he returned to the Vancouver Clinic for a medications management check. During the visit, the doctor noted that the cost of care continues to be an issue for Louie. He otherwise appeared normal.

"I had a sense in my heart that it was getting bad," Cindy said.

She said she couldn't get him back into Columbia River Mental Health.

"Would my son still be here now if he had been in the hospital?" she said.

Some argued that Louie played with death too often. Before his death, his mother estimated, he had attempted suicide seven or eight times.

Louie's official discharge papers from Columbia River Mental Health were entered on Feb. 12, the same day he was buried at Evergreen Memorial Gardens.

"Louie was seeking mental health assistance because he was experiencing psychosocial issues with occupation, housing and income issues. Louie was struggling to manage his symptoms, he had issues at home with his mother and substance abuse issues," said the discharge summary.

"Do I want my son back? God, yes," Cindy said. "Is it fair? It's not fair. We have to come to terms with our pain. We have to embrace it."

Copyright 2014 - The Columbian, Vancouver, Wash.