Summary report on the death of patient Maria Prevarian (MP-R12593) by Pierre Mare

Admission and and initial diagnosis

Mrs Prevarian, aged 54 at the time of her death, was admitted to this facility in April 2002, manifesting symptoms of paranoia, with occasional hallucinatory episodes. On admission, she was diagnosed with dendrophobia, fear of trees, however after refusal to enter her room and an incident in admission, the common area, the consulting psychiatrist's room and the dining area, the phobia was reclassified as xylophobia, fear of woods and wooden objects.

On the basis of a means assessment and acceptance of responsibility for payment by her family, Mrs Prevarian was placed in adapted quarters with:

• Plastic furniture and a steel divan
• In a section of the facility separated from the surrounding treeline by a distance of approximately 70 yards.

On observing subsequent episodes Mrs Prevarian was placed in deep sedation until the following measures were undertaken at the expense of the family:

• Plastic sheeting was put in place to obscure the ceiling boards
• Wooden wainscotting was removed and replaced with plastic strips.
• The plywood door was replaced with a steel door which was painted to fit with the décor of the rest of the facility.

Further incidents led to

• Attendants' wooden clipboards being replaced with plastic clipboards
• A prohibition on wooden pencils in the presence of Mrs Prevarian

Although she was ill at ease with the surrounding lawn, she was pacified by the expedient of keeping the curtains closed with tape until metallic blinds were installed. These were kept closed continuously.

She was prescribed standard anti-psychotics as indicated in her file, and received individual counselling in her room. Attempts to involve her in group therapy failed due to the presence of wood throughout the facility. Mrs Prevarian remained in her room until two days before the fatal incident.

She did not read as books produced a violent reaction in her due to their wood pulp content. She did not watch television, expressing fears about seeing trees. She was however given a CD player and listened to recorded books chosen by her family. These books contained no reference to nature.

Circumstances prior to admission

The onset of Mrs Prevarian's condition appears to have coincided with clearing of a space in a grove of trees on the family farm.  According to the family, several trees were removed to make space for a studio for Mrs Prevarian. Prior to the onset of her psychosis, Mrs Prevarian was a painter of some note.

According to the family, Mrs Prevarian's mother was violently opposed to removal of the trees, stating that the trees were brought as saplings from Greece, where a grove had been under the care of her antecedents for generations. This grove, the family stated, was an integral aspect of rememberance of the family's cultural heritage.

Mrs Prevarian reportedly dismissed her mother's objections and proceeded to have the trees removed.

According to the family, Mrs Prevarian's mother actively attempted to obstruct the removal of the trees. Her mother's behaviour and mental state cannot be established during the time as she is reported by the family to have lapsed into speaking Greek and only to her daughter, Mrs Prevarian. No report can be obtained from the workmen as they were killed in an accident while transporting the trees to a lumber yard.

After the trees were removed, the family reports that Mrs Prevarian's mother took to spending excessive amounts of time in the woods, in the vicinity of the new clearing, 'mumbling and singing'. She subsequently died in an accident involving a windstorm during which she was impaled by a branch which detached itself from a dead tree on the outskirts of the clearing.

Various assessments in Mrs Prevarian's file point to this period as providing the triggers for her psychosis.

Extract from therapeutic interaction with Mrs Prevarian: May 2002

AT: Attending therapist Vera Calvin
MP: Patient Maria Prevanian

AT: Mrs Prevarian, you have said that wood is alive. Can you explain to me what you mean by this?

MP: Wood. It is filled with the spirit of life. You may think it is just wood, but it is the carrier of life. You think that you cut a tree and it goes away, but the spirit is still there. It still lives.

AT: Do you mean the wood still lives?

MP: The wood lives. If the spirit wills it the wood will grow again. A dead stump. That can sprout leaves. A pencil. That can live again.

AT: Please tell me about this spirit.

MP: It is not one spirit. Some trees have them. Some don't. Many old trees have them. If the tree consents you may take a branch and replant it.

AT: Where do the spirits come from?

MP: My Great Grandfather brought them. He brought them from Greece. He brought the land with money from his village and planted them in the grove.

AT: Please calm down Mrs Prevarian. [Lengthy pause.]

AT: Did he plant the spirits?

MP: No. He planted saplings that he brought from Greece. The saplings gave life to the spirits in them.

AT: Where are the spirits now.

MP: I cut their trees down. Now they are moving. They are angry. Very angry. [At this point MP had an episode of hysteria and the interaction became unproductive. The interaction was terminated.]

(Recording 2002-05/S003-MP-R12593)

Progression of treatment

During the first three years of treatment, Mrs Prevarian refused to leave her room, except under heavy sedation.

From January 2006, a new medication regime was introduced , as documented in her file, and wood was gradually introduced into Mrs Prevarian's presence without violent episodes.

Extract from therapeutic interaction with Mrs Prevarian: March 2006

AT: Attending therapist Dave Brown
MP: Patient Maria Prevanian

AT: I am holding a pencil in front of you, Mrs Prevarian. Please tell me how you feel?

MP: [Pauses] It is a small thing. It will not harm me.

AT: Will larger pieces of wood harm you?

MP: [Pauses] They will not harm me.

AT: Will you go to the common area?

MP: [Pauses] I will go.

(Recording 2006-03/S002-MP-R12593)

Incident in Common Area 2: March 2006

Mrs Prevarian was introduced to Common Area 2 for non-violent residents at 09h30 on March 7, 2006. After some hesitation her attending therapist was able to induce her to sit on one of the oak chairs. In preparation for this, coverings were placed over the chairs to reduce possibility of a psychotic episode.

Mrs Prevarian talked to her attending therapist for a number of minutes before shifting in the chair. As she shifted in the chair the loose covering shifted, revealing a plant growth (a twig with a leaf) growing from the chair.

Mrs Prevarian displayed symptoms of extreme hysteria, and had to be subdued by psychiatric nurses. She was sedated in Common Area 2, by the psychiatric nurses in attendance, and removed to Observation Room 6, where she was diagnosed with catatonia.

Botanist report

A local botanist was called to explain the growth. He stated that this type of growth is not uncommon if a piece of wood is not sealed and treated properly. The phenomenon is common in lumberyards if wood is stored in rain or moist conditions. The sanitation staff were questioned, but none of them were aware of having seen the growth before. When queried on this, the botanist noted that the growth could occur over a period of days, weeks or months depending on the species.

The sanitation staff were cautioned to report similar growths and were told to remove furniture showing signs of growth.

The investigation was not pursued. The oak chairs have been replaced with more cost effective plastic chairs which pose less of a threat in the event of a violent episode.

Fatal incident in Observation Room 6

On 9 March 2006, a wooden beam above Observation Room 6 snapped, fell into the room below and crushed the chest of Mrs Prevarian, causing fatal trauma. The emergency medical response team was called and responded immediately but were unable to revive Mrs Prevarian.

In the incident, her heart and lungs were extensively damaged. Displacement of the beam following the initial collapse broke her neck and shattered her jaw. An autopsy showed that her death was instant and that emergency medical response would not have been able to revive her due to the extent of the trauma.

Structural investigation showed that a climbing plant extended shoots through the eaves above the western wall of the facility and grew unobstructed in the roof space above the facility. The weight of the climber and accumulated damp weakened the beam above Observation Room 6, leading to the collapse of the beam.

Mitigation and legal countermeasures

The legal representatives made the prescribed approaches to the family of Mrs Prevarian, offering compensation however the Prevarian family informed them that they 'would not profit from this', and that 'the matter was unavoidable'. The family signed a waiver of legal liability.

Grief counseling and interment

The Prevarian family was offered grief counseling as a matter of course, but refused the offer. Several of the staff who who became emotionally attached to Mrs Prevarian during her period in the facility attended her interment service. Some of the staff reported dismay that Mrs Prevarian was interred in the grove cleared four years previously. A number also reported that planting of nine saplings during the ceremony was in the poorest possible taste, but that Mrs Prevarian's daughter stated that it was 'as it should be'.