James Mark Rippee, who was blind, severely mentally ill, homeless — and unhelped, despite all the years that his sisters spent trying to change that — died on Tuesday at age 59.
You could say, as doctors at Fairfield North Bay Medical Center did, that he died of multiple organ failure after an untreated urinary tract infection caused sepsis. Or you could say that the cause was really the 1987 motorcycle accident that took his sight and part of his frontal lobe more than half a lifetime ago, when he was 24. Over the next few years, his brain injury robbed him of his sanity and safety, too.
You could consider some corner of accountability for the entrepreneur who had lately been charging him $600 a month to let him sleep in his backyard, along with other homeless people, though no one knows who left Mark at a Vacaville ER unable to breathe at 2:30 on Saturday morning, long after he should have received medical care.
Or you could say that he died because we just didn’t care enough whether he kept on living.
Sad as “everybody” found his extremely public predicament — “Everybody knows Mark quite well, and we do feel for him,” Solano County’s director of Health and Social Services, Gerald Huber, told me before I first wrote about Mark in August — nothing came of all that sadness as officials walked past him outside the county building where he slept most nights for the last 15 years.
“Now people will pay attention for a minute,” said his sister, Catherine Rippee-Hanson, crying in anger as well as grief in an interview at her home a few hours after her brother’s death.
She was having trouble breathing as she spoke, and hadn’t eaten or slept. But she and her 65-year-old twin, Linda Privatte, wanted to speak to me anyway, because they want the public to know what could have and should have happened but did not.
In trying to advocate for him and other severely mentally ill people over the last 35 years, Catherine said, “all I do is deal with misery and tragedy all day, trying to keep a smile on my face so people will still look at me,” and maybe even look at Mark. She and her sister and other family members cared for Mark themselves for the first 20 years after his accident, until his worsening mental health made that impossible.
“The next person who tells me it’s so sad, so sad” as if nothing and nobody could have changed how Mark’s life ended, she said, “I’m going to smack.”
“They waited us out,” Linda told her. “They were just waiting for him to die.”
Gov. Newsom vetoed right to treatment
Though I say “we” let him die, let’s call the roll: Gov. Gavin Newsom vetoed state Sen. Henry Stern’s “Housing that Heals” bill, which would have guaranteed the right to treatment for severely mentally ill and unhoused Californians like Mark.
Newsom was 1000% right when he said that we have to “take some damn responsibility for our ideals” by mandating treatment for those too sick to know they even need it. But without Stern’s crucial companion legislation, the Care Court bill that did pass can’t ever work as intended.
Mark thought the voices he heard were being broadcast by extraterrestrials from a military submarine using “mind warfare” to turn “almost every single person in my life against me.” Unseen guilty parties were, he told me, doing all sorts of unethical experiments on homeless people. And in that last delusion, was he altogether wrong?
Anyone who doubts that Mark was not capable of freely choosing or rejecting treatment can clear up his confusion by spending five minutes with one of the many severely mentally ill homeless people screaming nonsense at no one on the streets of Sacramento and every other city.
Another bill that might have kept Mark alive was state Sen. Susan Eggman’s legislation, which would expand California’s definition of “gravely disabled” to make it easier for people like Mark to get help. Though his initial diagnosis was a traumatic brain injury, he supposedly still didn’t qualify for a conservatorship on a medical basis. In Solano County, he somehow didn’t qualify for a conservatorship based on his mental illness, either. Every county interprets “gravely disabled” differently, an absurdity that Eggman’s bill would correct. Mark’s sisters feel that their county just didn’t want to pay for the public conservatorship he needed.
“He does have the ability to make some decisions for himself,” Solano County’s Huber told me last summer, and so was not considered “gravely disabled” enough to get the long-term residential treatment he so desperately needed. But, Huber added, that treatment wouldn’t be available anyway because even the prospect of funding something like that “is pretty bleak for small counties like ours.” And “every county has a Mark. Every county has multiple Marks.”
The definition of “gravely disabled” must be rewritten to include this word: anosognosia. That’s a condition associated with schizophrenia, which prevents those who suffer from it from understanding that they are ill rather than under attack from invisible evildoers.
After my piece about Mark was published by The Bee, Eggman went to meet Mark and met with his mother and sisters, too. “I found him to be incredibly resilient,” she told me on Wednesday. “He was a loving member of a family — he loved his sisters and his mother — and we should have been able to help him help himself.”
“She was so great with him,” Catherine said. “She really gets it.”
Others did not. The then-chairman of the Assembly Judiciary Committee, Mark Stone, never let her bill be heard. Eggman appealed that decision to California Assembly Speaker Anthony Rendon, but he decided to let Stone’s decision stand.
“Interesting @Rendon63rd would override a chair for a labor bill but refused to do the same for bills to address our mental health crisis,” Eggman tweeted at the time. “Ask the average Californian if unionizing capital staff is more important than addressing the ravages of severe mental health. Sad.”
Battle to help severely mentally ill continues
The voices of those who believe that Mark and other severely mentally ill people should be able to refuse the treatment that they don’t know they need have always been louder than those of the family members watching their loved ones die from lack of care.
The many opponents of what they see as “forced treatment” seem to think that running into traffic to escape imaginary torturers is just another lifestyle choice.
These are “good people, with good hearts and good intentions,” says Teresa Pasquini, of Contra Costa County, whose son is severely mentally ill. “But people in Sacramento don’t understand how these laws translate on the ground. They don’t know what they don’t know” and so end up telling “fairy tales” about how they’re supposed to work.
In New York, the pushback against New York City Mayor Eric Adams’ brave new plan to treat severely mentally ill homeless New Yorkers was both fierce and foreseeable, but he’s still right.
Because if we’re ever going to stop the suffering of folks like Mark while they’re still breathing, we’re going to have to stop protecting their right to die screaming, scared and usually alone.
Mark was not alone, and couldn’t say anything because when he tried to refuse medical treatment to help him breathe, doctors put him in an induced coma and intubated him; somehow, forcing that treatment to save his life was OK, while forcing psychiatric treatment to save his life never had been.
His sisters, niece, mother and her husband were all with Mark when he died, as Catherine and his mother held his hands and Linda stroked his head.
“All of the nurses in the room already knew Mark’s story; they were kind and supportive,” Catherine said. “I told him he could go.”
“And all I could tell him was I’m sorry,” said Linda.
Now Mark “will no longer suffer in a world that could not accommodate him,” his sisters said in his death notice. “The joking way he had and the smile on his face will be missed. It is clear that our community cared for him a lot, and we told him that many times. The way he saw it ... thanks to us, he had become famous. His presence will be missed by so many who understand what he endured for so many years. The burdens he carried ... fear, anxiety, and depression are gone ... as well as the voices. Never again will he shiver in the cold or fade in the heat on a sidewalk. We hope you are at peace, little brother. Those who loved you will always carry your memory in their hearts.”
That Mark was so loved in some ways only makes this loss more frustrating; his sisters did everything but set themselves on fire to get him help. And many in his hometown did look out for him as best they could.
But he was often robbed and beaten on the street, and was sexually assaulted more than once, Catherine told me.
In the end, she said, “he died of common ailments, because he didn’t know he needed to go to the hospital. He didn’t have to die,” she said, and cried harder. “It’s been such a long battle, and it’s a battle we did not win.” Yet even now, she and Linda intend to keep pushing for Eggman’s bill and other laws that would help somebody else’s brother.
“We’re coming back with it again this year,” Eggman said, and with Stone no longer in office, she’s hopeful that this time, it will pass.
It should become law, and that law should be named for James Mark Rippee, whose lifetime of suffering still requires the action that he didn’t live to see.