Lawyers have the luxury of blaming other people for the ills of the world, because they make no claims to provide any benefit from their own services.

Yesterday on TruTV I heard a legal commentator say that America’s mental-health providers need to do a better job identifying and treating people like Alvaro Castillo to prevent school shootings. Apparently even Judge Allen Baddour blamed the situation on a system that did not “get [him] the help [he] needed.”

In this non-lawyer’s opinion these are outrageous remarks and completely wrong-headed. (BTW: I hope defense attorney Williams will appeal this verdict successfully.)

I can argue that in fact it was the law and the lawyers who failed Alvaro Castillo and all the other school shooters of the 20th and 21st centuries (to paraphrase Alvaro). And I will.

University Hospitals and Medical Researchers Under Legal Siege

Dr. Karen Graham and Dr. Nicole Wolfe of the University of North Carolina testified against Alvaro Castillo’s claim of insanity under the law. Not surprisingly. After all, the defendant was first treated at a UNC clinic and then discharged because he did not qualify for their treatment program, which focuses on some other sort of mental disorders. (I think they said the Oasis Clinic specializes in early-onset psychosis.) Then, when a second clinic’s doctors tried to convince the UNC doctors that Castillo actually did have early-onset psychosis, the UNC clinic refused to take him back.

This situation has mega-law-suit written all over it. Everything the UNC doctors said on the stand sound to me (a non-lawyer, non-psychologist) like CYA.

But I sympathize with them, and I understand what’s going on these days at university teaching hospitals.

• Sidebar: I have been tangentially involved in hospital services since the early 1980s (I didn’t realize it until just this moment, because my involvement is so tangential.) In the early 80s I worked for a software company that specialized in hospital financial systems. There I learned the impact of lawyers on a hospital’s financial viability. In addition, through my association with the University of Chicago, I have been an innocent bystander in the university hospital’s ongoing battle with the communities surrounding the campus over its emergency room, which was once the leading trauma center on the south side of Chicago. And very recently I had to deal with “end-of-life issues” at two hospitals, one private and one government.

I suppose very few people understand that most hospitals in this country are private, non-profit organizations. Despite hospitals’ public necessity, the government owns and runs few hospitals.

The reason most hospitals are private rather than public is that the public cannot afford to support hospitals (as we are learning through the current health-care debate). But private hospitals are also very expensive, and they have to protect themselves from financial ruin by being selective of which services they provide (they specialize in certain areas) and by reserving the right to refuse to treat any given patient.

University hospitals (even state-owned university hospitals such as North Carolina's) have an added burden. Their mission is to train health-care practitioners (“teaching hospitals”) and conduct medical research. Both of these endeavors are “risky” and therefore costly.

As institutions of higher learning they must staff their hospitals with faculty members and students, as well as provide health care first and foremost to the university community. As research institutions, they must compete (both nationally and internationally) for federal grants, private endowments (such as from pharmaceutical companies), and other charitable sources of funding. Their research activities are carefully scrutinized by these sources, as well as by the public. (As an example, consider how a university’s research into stem cell technology is conducted in the public spotlight.)

The potential for law suits against a university hospital is enormous. It happens all the time. Payouts impact the financial viability not only of the hospital, but the entire university—and in this case the entire State of North Carolina.

I am convinced that the UNC doctors who testified against Alvaro Castillo did so to avoid lawsuits against the university. Ultimately, it was tort lawyers who failed Alvaro Castillo, not the NC health-care system.

Laws of Gun Ownership

If I understand the situation correctly, in April of 2006 Alvaro Castillo attempted suicide and voluntarily entered the UNC hospital. He was released after a week and then was treated at the UNC Oasis Clinic by Dr. Graham. Shortly thereafter Castillo legally purchased firearms.

The law is at fault here, too. The law in North Carolina concerning who is eligible to purchase firearms is apparently filled with loopholes. Because Castillo entered the hospital voluntarily, he was technically eligible to buy guns: the NC law does not consider voluntary hospitalization to be “commitment” to a hospital. This stupidity is classic legalese.

Laws against Involuntary Hospitalization

Second, it is the law that makes involuntary hospitalization impossible. In the mid-1970s the ACLU, among other civil-rights groups, argued successfully before the U.S. Supreme Court that involuntary hospitalization is a violation of the civil rights of the mentally ill. Now, a person may only be hospitalized involuntarily for a very short time, after which he may choose to check himself out, as did Alvaro Castillo. He wasn’t kicked out of the hospital.

Laws and Regulations Driving Insurers Out of the Mental Health Market

In all the discussion of health-care reform I have not once heard anyone mention mental health. I have no idea whether it is included in any of the reform plans. However, I do know that as things now stand mental health care is incredibly costly and often not available at all.

Under Medicare/Medicaid only psychiatric care seems to be covered. Counseling and therapy by psychologists does not seem to be covered. This, I take it, is because government-funded health care covers only “necessary” and “appropriate” non-experimental treatment. Under the law, psychiatry is deemed to be medicine, while psychology is deemed to be quackery. (IMHO, exactly the opposite is true.) In other words, under government-funded health care you can take a pill but you can’t talk about your feelings.

A person who by reason of youth or income is ineligible for Medicare/Medicaid must pay for his own mental-health care. If he has private insurance, there are severe coverage limits on the amount and nature of the treatments and drugs he may receive.

Mental-health professionals, as with all doctors, must follow treatment guidelines provided by the insurers. This means that therapists, for example, cannot innovate or even adapt treatments to the needs of individual patients in some cases.

Insurance companies, for example, allow mental-health providers to lobotomize a patient or administer shock therapy but not to administer drugs not yet approved by the FDA. The FDA, in turn, forces pharmaceutical companies to conduct lengthy studies of drugs in use around the world before they can be used in this country.

Excessive regulations and the threat of lawsuits not only drive up mental-health-care costs, they actually dictate treatment plans.

Laws against Family Guardianship

Our nation’s laws have difficulty with the notion that some people are better off as wards of a responsible guardian. In addition, our laws have no way of determining when the guardians themselves are the problem, not the solution.

Consider the plight of children: parents are free to abuse and neglect their children until the abuse and neglect becomes impossible for them to hide. By then, of course, it’s too late.

Consider the plight of spouses and domestic partners of criminals and the mentally ill or sociopathic: what goes on behind closed doors is sacred to Americans. No one will open the door, often even when they hear screams of the tortured.

Consider the plight of the elderly who have dementia: an old person can live in squalor, eat dog food, and give his money away to con artists. If a caregiver tries to intervene, only a judge can decide to do anything to help the old person.

Don’t believe me? Here’s a specific law that prevents the adult children of parents on Social Security from helping their parents with anything, including preparing their taxes for them:

Imagine that your elderly mother doesn’t open all her mail, especially envelopes that look like they might be bills or legal matters. As a result, she doesn’t open her annual letter from the SSA with her W2 form in it. When you try to do her income taxes for her several months later, the W2 form is missing. If you call the SSA and ask them to send you a duplicate W2, they will tell you that they cannot do that. Your mother must call them herself and request the duplicate. In addition, they will only be able to send the duplicate to her address (which is hundreds of miles away from you) where she will promptly not open it and lose it again. The only thing they can advise you is to have her name you as her personal representative for SSA purposes. To do that, she has to fill out a form, which they can mail to her--if she personally requests it. In addition, thereafter you will be the one who actually receives all her SSA transactions, including her checks, which you will then have to deposit in your bank account and then transfer to her bank account for her to live on.

A Man’s Home Is His Castle Mentality (Legal Misinterpretation of Privacy Rights)

First, notice that they never say, “A woman’s home is her castle.”

Western society is still medieval in many ways. Once upon a time, a castle was a sovereignty, a legal entity unto itself. Inside a castle’s walls, the lord was master. Every life was “suffered” to live by his will alone. Everything inside the castle’s walls was the lord’s private property. Even a king could not tell his vassal lords what to do inside the lords’ castles.

Private Property: This is the essence of the law established by the Magna Carta, from which our Constitution is ultimately derived.

Even now, our laws still acknowledge that private property is fundamental to liberty, because private property is our shield from government interference in our private lives. And I am a great believer in this principle.

But the problem is that this castle mentality is hierarchical in and of itself.

Even now (when we imagine that women have equal rights with men) within the walls of a home one person is the “head of the household” (if you don’t believe me, take a look at last year’s 1040).

Granted, the head of the household’s rights have been considerably restricted since the year 1215. But the fundamental principle that one’s private property is one’s to do with as one chooses, remains the same. (I used the word “one” intentionally, because it is always one person who is in charge. Admit it.)

The consequence of this hierarchical household structure is that an evil head of the household can do a great deal of harm to his family.

This is another way the law failed Alvaro Castillo. The law enabled his father to terrorize his whole family. No one intervened soon enough to save Alvaro, because no one was permitted to intervene behind the closed doors of the Castillo family.

Toward the end of the Castillo tragedy, the mental-health practitioners who were treating Alvaro did not know he had purchased firearms, because the law required them to respect Alvaro’s privacy (he was over 18) and required them not to reveal anything about his treatment to his parents. So they could not even call his parents to see whether or not he was telling them the truth during his sessions with them.

This is not a failing of the health-care system. This is a failing of the law.

The Letter of the Law: Laws Are Nothing But Strings of Letters

The problem with the law is that the law is nothing but words, and the people who write these words do not write well.