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Rita Carol Barsky, Ph D, CASAC

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Interview: Take 12 Radio

I was interviewed by Take 12 Radio shortly after the medical examiner confirmed Heath Ledger died of an accidental drug overdose. To down load the audio clip of my interview click here.

Op Eds

Newsday, Monday, November 19, 2007

By Rita Carol Barsky, Ph D

According to autopsy reports released this month, Carol Gotbaum, who died in late September while in police custody at the airport in Phoenix, had acute ethanol and prescription medication intoxication at the time of her death.

Officially, Gotbaum died of "asphyxia by hanging," and the death was ruled an accident by the Maricopa County medical examiner. Last week, a private pathologist hired by the Gotbaum family (she was step-daughter-in-law of New York City Public Advocate Betsy Gotbaum) blamed police for her death.

When I first read about the circumstances of Gotbaum, I had a sinking feeling that she was an alcoholic, even though initial reports offered no indication of that. She had missed her connecting flight and apparently became so upset that airport security had to subdue her. Ultimately, they put her into a holding cell, shackled to a bench. She died as a result of this treatment. I couldn't help but wonder why no one thought to call for medical attention or for an ambulance, if she was so hysterical. But I know why. She smelled of alcohol, and it seemed she had been drinking, so she wasn't considered sick.

The actions of the security personnel reflect the attitude that many people have toward alcohol. Gotbaum was heard yelling, "I'm not a terrorist, I'm a sick mother," but her pleas were discounted. Because she appeared to be "under the influence," it seems she was not seen as a human being in need of medical attention.

The thought that this situation was a medical emergency may not have even crossed the minds of the security personnel. Instead, it appears the security personnel based their actions on their unconscious feelings about individuals who drink.

Millions of people in the United States and around the world who suffer from chronic illnesses are treated with dignity and respect when their symptoms are present and obvious. Individuals with alcohol dependence are not so fortunate. Mostly they are shunned, disrespected and looked down upon by loved ones and society alike.

It's time for ignorance, shame and guilt to stop killing seriously ill people. Even though there has been progress in this area and, due to irrefutable biological evidence, today alcoholism is accepted as a disease by many scientific and medical experts, that's not enough. Carol Gotbaum's death clearly demonstrates that fact.

There are choking posters in most restaurants. There are signs in bars and restaurants that serve liquor warning of the dangers of alcohol to an unborn fetus. There are defibrillators on airplanes. These tools are the results of efforts to address serious public health issues. So if a significant portion of the world's population drinks alcohol, why isn't there an appropriate system in place to handle intoxication?

Police and security personnel should be trained to understand the seriousness of a drunk and disorderly event. Drunken behavior reflects the neurological effects of alcohol on the brain and should be deemed a medical emergency, not a criminal act.

There are innumerable reported instances of individuals who drank alcohol, fell asleep or passed out, regurgitated in their sleep, and choked on their own vomit. For every reported incident of death as the result of this type of strangulation, there must be at least as many alcohol-related deaths that go unreported.

Alcoholism is a chronic disease, and it needs to be treated as such. When someone appears to be intoxicated, there should be procedures in place to prevent tragedy. The situation should be treated as a medical emergency. 911 should be called. The patient should be monitored for potential life-threatening problems like vomiting, seizures, or respiratory or cardiac arrest.

It's distressing to think of how many people, having been labeled as "unruly drunks," may have died in similar circumstances, but their deaths went unnoticed because their families didn't have the clout that Carol Gotbaum's does. The attention this tragedy has received should help to change procedures. And the first rule for security personnel should be to obtain proper medical attention - not to leave someone alone to suffer and die.

The Journal News

Change is needed in emergency responses to intoxication cases

By RITA CAROL BARSKY

(Original publication: November 27, 2007)

What does a privileged woman from the Upper West Side of Manhattan and a Guatemalan homeless immigrant man have in common? They both died alone and suffering without any medical attention. They died as a result of ignorance and bias on the part of the people who were entrusted to keep them safe. Both of these deaths could have been easily avoided.

A man calls 911 and asks for medical assistance and instead he is transported out of the police jurisdiction, where he dies. A woman is late for her flight in an airport, arrives at the gate smelling of alcohol, gets arrested for disorderly conduct and is found dead in her cell within an hour of her arrest. In both cases they pleaded for help but instead they received disrespect and treatment that ultimately led to their death. The woman was heard yelling "I'm not a terrorist, I'm a sick mother." She was handcuffed and dragged off to a cell where she died. The man called 911 and asked for a ride to a hospital. The police responded and allegedly drove him to a remote spot and left him to die.

(The writer refers to Carol Anne Gotbaum, who died Sept. 28 in Sky Harbor International Airport in Phoenix while being held in police custody; she was arrested after becoming angry while attempting to board her plane to enter an alcohol treatment center in Tucson; and to Rene Javier Perez, homeless immigrant and known alcoholic, who died early April 29 at Westchester Medical Center allegedly after being left by Mount Kisco police officer George Bubaris on the side of desolate Lake Byram Road in Bedford. Bubaris faces manslaughter charges. - Editor.)

The police officer that arrived on the scene didn't believe that this man had a medical emergency. All he saw was a problem drunk whose life was of little or no value, and treated him like trash. This is an extreme example of the consequences of ignorance regarding alcoholism. Unfortunately when someone is intoxicated they are difficult to deal with and can be belligerent, uncooperative and at times violent, but the fact is that intoxication is a life threatening condition.

Both of these individuals had been drinking and the attitude of the security guards as well as the police officers was in effect distorted. They were not seen as human beings in need of medical attention, and the thought that both of these situations were medical emergencies never even crossed their minds. If it had both of these people would be alive.

In hindsight it is clear how both situations were medical emergencies. What happened? I don't believe that the police and security personnel are evil or stupid. They were responding to their feelings based on core beliefs or attitudes.They would probably have responded quite differently had the victims been suffering from any other chronic illness. I know that in both of these situations whatever assessment was made, it was not determined that medical assistance was required and in both situations someone died unnecessarily as a result of that.

Recently I was talking to someone whose mother has dementia. She described a scene in which a woman with dementia was belligerent, uncooperative and aggressive toward the staff that was attempting to assist her; very similar to when someone is intoxicated. It was necessary to restrain her in a chair. The medical staff did not leave her alone in a room or on a remote road where she could not get medical attention if it was required. They were respectful and professional and took appropriate precautions to ensure the safety of the patient and themselves.

Intoxication is defined as the state of being intoxicated, of being poisoned by a drug or toxic substance. There needs to be a new way to approach this problem, and it should be adopted by all persons who are in a position to prevent such tragedies. I propose that a formal procedure for the treatment of individuals who appear to have been drinking be adopted by law enforcement, security personnel and educators. Intoxication should be treated as a medical emergency, 911 should be called and the patient should be monitored for potential life-threatening events: Vomiting, seizures, respiratory or cardiac arrest.

The question is: What should be done about avoidable tragedies that involve the appearance of alcohol consumption? First and foremost a change in attitude is required. First responders and other personnel dealing with the public must be taught that when an incident involves alcohol consumption it is a medical emergency and must be treated as such. Alcohol consumption, whether chronic or acute, is extremely dangerous for the person who abuses it.

The writer, who lives in Deer Park, has been an addiction counselor for more than 20 years in New York City.