Todd Arko relapsed to using cocaine when he was still on probation for possessing the drug, then decided he would rather die than go back to jail. At the age of 53, he tried to hang himself. The rope broke, crushing his heels as he collapsed to the ground.
Arko is identified in federal documents only as Patient No. 5, the homeless, suicidal man the feds say was placed in immediate jeopardy by Parkland Hospital. In a report, the Center for Medicaid Services describes how Parkland discharged Arko too soon, to a homeless shelter unable to care for someone recovering from a recent suicide attempt, crushed heels, a fractured right arm and a fractured spine. Despite his obvious mental health problems, the hospital never gave him a psychiatric evaluation. And when he told the hospital that he didn't feel safe leaving, they called the cops, as we reported last week.
Parkland wasn't the first facility that Arko's family says seemed more interested in pushing him away than treating him. A letter that the Center for Medicaid services sent yesterday to the Green Oaks hospital chain, obtained by the Observer, tells the hospital that they too placed a patient in "immediate jeopardy" and may lose Medicaid funding as a result. Arko received psychiatric treatment there before his stay at Parkland.
Yet somehow, Arko has survived the ordeal. While he was bouncing around between facilities and eventually a hotel room that a friend put him up in, he stopped reporting to his probation officer like he was supposed to do, so a judge issued a warrant for his arrest. Now he's back in the Dallas County jail, the very place he tried to kill himself to avoid.
Arko used to run automotive centers but lately was supporting himself with odd jobs. He was never successful like his siblings and could feel extremely depressed at times. "When I get to that point, I do something stupid that brings me down," he said in an interview Wednesday at the Lew Sterrett jail.
Already medicated for mood swings, he used cocaine only sometimes, he says, during rough patches. "Whenever a girl leaves me, I'll go on a one-week binge to get over the pain," he said.
He wasn't much of a criminal. His first charge in Dallas County came last year, after police found him sleeping in his truck. He says he was recovering from a long night in Dallas with two prostitutes and on his way home, which at the time was a room he rented for $500 a month in Plano. He pulled the truck over in Dallas to get some rest and awoke to cops knocking on his window. They searched the truck and found crack residue on the driver's seat. "The substance was not contained in any packaging," a police report says. He pleaded guilty to possession.
When he relapsed this summer, he says he told his probation officer, who warned him that he would have to go back to jail before being sentenced to rehab. He wanted to die because he didn't think he belonged in detention.
"I'm not a criminal, I'm an addict," he said. "To me, a criminal is someone that does something to violate others."
After the failed suicide attempt, his landlord rented out his apartment to someone else, leaving him with no home. A doctor at the Medical Center of Plano treated Arko and said he'd need surgery on his heels in about seven days, after the swelling went down, according to Marybeth D'Amico, Arko's sister who lives in Virginia.
Arko was on NorthSTAR insurance, a publicly funded program for people suffering from mental health problems and substance abuse, and D'Amico thought her brother would be able to qualify for Medicaid and other charity programs set up through the hospitals.
"I was hoping he'd be able to get his surgery and then go to a physical rehab [clinic], and then we had planned to put him in Team Challenge," a drug rehab program, D'Amico said in a telephone interview.
In the meantime, the doctor in Plano transferred Arko to Green Oaks, a Dallas-based psychiatric hospital, where he was supposed to recover. But after staying there a week, the Green Oaks case manager wanted to discharge him, D'Amico says. D'Amico and a sister in San Antonio protested the decision by phone and email, requesting that Green Oaks transfer their brother to a physical rehab facility instead. The Green Oaks case manager agreed to look into a charity program at Baylor Hospital.
But Baylor rejected Arko, claiming that his physical injuries were too severe even for their physical rehab program. "Based on the clinical information we received and the patient being non-weight-bearing, we did not discuss the patient with our charity committee," Janine Membreno, the director of business development at the Baylor Institute for Rehabilitation, explained in an email to Parkland officials. "The requirement for inpatient rehab is that the patient must be able to actively participate in 3 hours of therapy."
So Green Oaks instead discharged him to a boarding home, one of the publicly funded facilities for people with mental health problems. But the room was depressing, with no furniture, Arko says, and no easy way to get in and out in a wheelchair. He slept on a box-spring mattress, unable to keep the weight off of his legs like he was supposed to do. He still had his truck but was chauffeured around at the time by Metrocare, a nonprofit that provides transportation to people suffering mental illness.
With Arko still in pain, the Metrocare driver agreed to take him to Parkland Hospital's emergency room on July 19. His legs and hand were re-splinted and he was admitted to a bed, while doctors discussed performing surgery on his heels and right arm. "They all agreed to follow through with surgery despite the possible risk of infection," D'Amico writes in an email.
Yet by the next day, the surgery was off. D'Amico found out when she got a call from her brother, telling her that Parkland decided to discharge him to a homeless shelter. "I told Todd not to leave till I could figure something out," D'Amico says by email.
The cops showed up and asked Arko to leave, so he did. He waited outside in the parking lot while his sister got on the phone with a patient advocate, who agreed to readmit him to Parkland for a night. But soon afterward, Parkland wanted to discharge him again. With Arko still frightened about staying in a shelter with his casts, a friend called him up on his cell and said she could place him in a Marriott with some old reward points.
"Todd is still living alone in a hotel and is forced to have to continue to bear weight to his lower extremities," D'Amico wrote to Marilyn Callies, Parkland's vice president of care management, on July 25. "Since your team decided against surgery and we are no longer in that window of opportunity for potential surgery, yet Todd is still at risk for significant injury if non-weight bearing status is unattainable, would you please consider having your team contact Baylor Inpatient Rehab for treatment?"
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Parkland agreed to try Baylor's rehab clinic again, but Baylor still didn't want him. Callies, the Parkland vice president, suggested to Arko's family in a July 30 email that his relatives take care of him instead. "The majority of our patients with functional and financial limitations are supported by their families and are allowed to stay with them," Callies wrote in the email. "When patients are not able to stay with family, we explore other options including community resources such as Boarding Homes, the Bridge, Union Gospel Mission and other shelters."
Arko was still staying in hotels, driving himself around in his old truck last month, when he says an officer pulled him over for speeding. The officer saw he had a warrant out for his arrest, and he's been in custody ever since.
Arko now walks slowly through the Dallas County jail with help of a walker. One foot still feels numb and his back hurts. His next court date isn't scheduled yet. Parkland officials didn't return messages for this story, though their plan for improving patient safety has already been approved by the Center for Medicaid Services. A spokesman for Green Oaks hospital says the facility is still waiting for clarification from Medicaid on where they went wrong.
Arko's most recent Parkland appointment, he says, was yesterday morning. The doctor gave him a new X-ray, he says, but wouldn't show him the image. Instead, the doctor showed Arko an older image of his fractured vertebrae, and explained that Arko didn't need to come back anymore. "No reason for any more follow-ups," was the last thing Arko remembers the doctor telling him.