Signature Healthcare: Federal Lawsuit Charges Vista Del Mar Hospital for Discharging Patient who Murdered Mother

November 7, 2023

Tomoko Hoetzlein fought for years to help her son David deal with severe mental illness, from reading about brain research and making sure he took medication to letting him live with her despite the growing risk to her safety.

The 62-year-old Camarillo woman’s struggle ended with her death in June of last year when she was strangled. Her dismembered body was found in a trash receptacle outside the apartment she shared with her son.

David Hoetzlein, who had just been released from a psychiatric hospital two days earlier, was arrested on suspicion of his mother's murder. The 26-year-old man diagnosed with schizoaffective disorder has since been found incompetent to stand trial three times and has not yet entered a plea.

Tomoko’s daughter, Mao Cardenas, said it didn’t have to come to this.

“The thing that’s maddening is we asked for help, and it fell on deaf ears,” she said.

The Vista del Mar psychiatric hospital and the County of Ventura – two major defendants in a federal civil rights lawsuit that Cardenas filed over her mother’s death – deny fault as well as legal responsibility.

Both parties were involved in key decisions made during Tomoko’s last days when family members tried to keep David confined and in treatment.

Tiffany North, the county's chief civil legal counsel, declined to comment because the matter is in litigation. Vista del Mar CEO Colton Reed did not return a call seeking comment.

The Ventura hospital released David on May 31, 2022, after an 11-day stay in what state healthcare licensing officials later called an unsafe discharge. The state officials cited Tomoko's death as well as deficiencies in planning his treatment and discharge in their investigative report issued in January.

Then last month, Ventura County cited David Hoetzlein’s discharge as one of a series of patient care issues in its decision to suspend Vista del Mar’s authorization to admit involuntary patients.

In Vista’s answer to the lawsuit, the hospital said David was no longer being held involuntarily at the time of his release, suggesting he was free to go.

Family members had asked the hospital to initiate a conservatorship that could have led to his transfer to a locked rehabilitation facility for a year or more, but from all appearances, the hospital did not do so.

An attorney for Vista did not respond to a question on why a hospital psychiatrist didn’t initiate the conservatorship.

Only a psychiatrist or a psychologist can start the process, typically while the patient is still being held in the hospital, said Dr. Jason Cooper, medical director of the inpatient psychiatric unit at nearby Ventura County Medical Center.

A series of attempts to get help

On June 1, the day after David was released, Tomoko asked Ventura County sheriff’s deputies to detain him on a 72-hour mental health hold after he allegedly stole her car and battered her, Sheriff’s Capt. William Hutton said.

Officers evaluated him but determined he didn’t qualify. He was not considered a danger to self, a danger to others or gravely disabled due to a mental disorder. Nor was Tomoko willing to press charges so he could be arrested and jailed, as families commonly are not.

She may have reached out four more times for help that night, less than a day and perhaps just hours before her estimated time of death.

Phone records reflect she telephoned police at 9:32 p.m. and 9:33 p.m., but that each call lasted only a minute, indicating that no one may have answered, the lawsuit says. She then made two calls to an employee of the county Behavioral Health Department at 9:38 p.m. and 9:43 p.m., according to the suit.

Cardenas' attorneys say the latter calls should have been relayed to the county's mobile mental health crisis team. County spokeswoman Ashley Humes declined to answer questions about the phone calls to behavioral health or the response, citing laws protecting patient confidentiality.

If deputies had taken Hoetzlein in for an evaluation, he could potentially have been treated and held up to 17 days against his will under the policy in effect at the time.

A mental health conservatorship was a more permanent solution that could lead to his transfer to a long-term, locked rehabilitation facility. Tomoko desperately wanted one so her son would get the help he needed and avoid drugs, said Irene McThomas, who said she spoke with Tomoko for hours during the last five weeks of her life.

Conservatorships allow another person to take over decisions for people with severe mental illness at least temporarily. The conserved person must be shown to be “gravely disabled,” which is defined as unable to obtain food, clothing or shelter due to a mental disorder.

“It is an extremely high bar to meet,” said Dr. Joseph Vlaskovits, a forensic psychiatrist.

But Tom Hoetzlein, David’s father, said his son fully met the criteria. Tomoko had prepared a document showing his deficits in various areas, including emotional instability and inability to maintain gainful employment. He could never survive on his own, his father said.

He said he never thought his son would do what he’s accused of.

“I knew he had a propensity to lack of inhibition and control, but I didn’t think it would go this far,” his dad said. “None of us did.”

He suspects David snapped because the level of medication he was given at Vista wasn’t what he needed to control his symptoms. The young man is suspected of choking his mother to death after they argued over a credit card bill. State officials found that his unsafe discharge may have contributed to his mental deterioration, leading to his arrest three days later.

Tomoko’s dismembered body was found on June 3. She was killed sometime between 11:20 p.m. on June 1 and 3 p.m. on June 2, according to a court document filed by the District Attorney’s Office.

Cardenas is seeking undefined financial damages in her 113-page federal lawsuit, alleging wrongful death, civil rights violations and neglect of David while he was in Vista's care.

She also hopes the litigation will lead to systemic change. She sees a need for improved staff training and procedures when families are facing a mental health crisis with a loved one.

Her mother “didn’t have to die taking care of her son,” she said.

Remembering better times

Cardenas, a 39-year-old resident of Los Angeles County, remembers better times for both her mother and brother.

Her mother was a native of Japan and exchange student who moved to the U.S. and worked as an assistant in a legal office. She couldn’t work full-time because of David’s needs, Cardenas said. She quit a paralegal training program one semester short of completion so she could move in with him because he was deteriorating, according to her daughter.

David’s father said it would be hard to find a more dedicated mother. She lined up piano teachers, hired a pitcher from the San Francisco Giants to improve his skills on the mound, took him to Japan in the summer so he could learn the language.

Cardenas recalls him as a boy who liked video games and Harry Potter.

He was never known to get in fights, she said, and was a sociable person. He completed high school in Ventura County but was never able to hold down a job for long.

He was diagnosed in 2018 with the bipolar type of schizoaffective disorder, which is marked by symptoms of schizophrenia along with depression and mania. It took doctors at UCLA three years to come up with a dosage of drugs that stabilized him, but he would stop taking the medication and relapse, Cardenas said.

'His No. 1 cheerleader'

Tomoko told McThomas in their conversations that she never wanted to press criminal charges against David because she feared he would be sentenced to a long prison term under California's "three strikes" law. The voter-passed law allows offenders to be imprisoned for decades if they are convicted of three violent or serious felonies, but it does not appear that he was actually in jeopardy of that.

Cardenas said her mother put her son's needs above her own.

"She was his No. 1 cheerleader and just wanted him to get better," she said.

Source: Kathleen Wilson, “She 'didn't need to die': A Camarillo mother's tragic end to help her mentally ill son,” Ventura County Star, Nov. 3, 2023, URL: https://www.vcstar.com/story/news/2023/11/03/camarillo-mothers-tragic-end-to-help-mentally-ill-son/71438865007/