Flanary couldn't be calmed expert says

By Amy M. E. Fischer

May 05, 2005

TACOMA -- A forensic psychiatrist testified in federal court Wednesday that Daniel Flanary's manic state posed a significant danger to others, and any attempt by Kelso police to pacify the bipolar teenager would likely have failed.

"I have no criticism of the way they handled this incident," Dr. Emily Karem said of the six officers involved in Flanary's fatal shooting in West Kelso on the night of Feb. 19, 2001.

The intense manic episode that consumed Flanary had progressed so far that restraints, seclusion and medication would have been required to calm down the raving 19-year-old, said Karem, a doctor and psychiatrist who developed crisis intervention training programs for California law enforcement agencies.

In cross-examination, Flanary family attorney Bill Coates asked Karem to read from an officer field training manual she had a hand in writing. The field guide said that when dealing with mental patients, officers should take things slowly, keep their distance and collect as much information about the person as possible.

Karem contended that those things didn't apply in Flanary's case, because he posed a physical threat to the officers and had been violent in a previous manic episode a few weeks before. Coates, however, pointed out that the police on the scene that night didn't know Flanary's history.

Flanary's parents are suing the city of Kelso, accusing police of using excessive force when an officer shot and killed the teenager, who menaced officers with a pair of flattened teaspoons he used as musical instruments.

In her half day on the witness stand, Karem reviewed Flanary's postmortem toxicology report. She also reviewed medical records complied during his 16-day stay in the mental ward of St. John Medical Center from Jan. 27 to Feb. 12, 2001.

Karem testified that Flanary's bouts of manic behavior on Jan. 27 and on the night he died were triggered by antidepressant medications. He received those medications from his mother, who gave them to him from her personal prescription, Karem said.

Antidepressants will shoot you into a manic episode if you're bipolar, Karem testified. (Bipolar disorder is characterized by alternating periods of manic behavior and mental depression.)

Traces of Trazodone and Elavil, both antidepressants, showed up in Flanary's toxicology report, said Karem, who is charging the defense $400 an hour for her services.

The mood stabilizers Flanary was prescribed upon his release from the hospital were not found in his bloodstream, Karem testified. Bipolar patients must take medication every day of their lives to reduce the chance of a manic episode, she said.

Karem told the jury in that the best predictor of future violence is past violence. Based on Flanary's violence during his manic episodes at the hospital, Karem concluded that attempts by police to use verbal de-escalation techniques and tactical retreat with Flanary on the night of the shooting were highly unlikely to succeed.

"I don't think those techniques would have worked. They didn't work in the emergency room" or in the first six days of his hospitalization, Karem said.

In the emergency room on Jan. 27, Flanary "exploded" and attacked hospital workers in front of his family, Karem said. In addition, for the first six days of his stay he was kept in seclusion. Police were called twice to help hospital staff strap his hands and fee to the bed, a step prompted by Flanary's tendency to fling himself and his mattress at the wall.

He told a psychiatrist at the hospital that "the devil was in his spit," and on his fourth day there he told another staff member to give him a knife so he "could cut off his finger and eat it," Karem said, reading from medical records.