Mom hopes daughter’s death from huffing inspires change

April 08--Kay Kramer was alarmed when her daughter sent her this text message: "I want to die."

Amy Sell had battled addictions and mental health issues for years, so her mother rushed to Amy's apartment in Shillington.

By the time Kay arrived, she could see through a window that the 29-year-old was passed out on her bed.

The 2002 Conrad Weiser High School graduate had been huffing, or breathing fumes to get high, from cans of spray cleaner that are supposed to be used to blow dust off keyboards and other electronics.

Kay knocked at the window and hollered for several minutes but could not rouse Amy, so she called police.

An officer soon arrived and removed an air conditioner from a window to crawl inside.

He shook Amy until she gained consciousness, but she was confused and crying.

"I'm sorry, I'm sorry," she repeated.

She had sustained a cold burn, a type of frostbite, on her hand from the spray cleaner because of prolonged exposure to the can's freezing temperatures caused by gas used as a refrigerant in the can.

She had injured herself so badly in her pursuit of a high that one doctor even feared Amy might lose a finger.

Kay wanted Amy involuntarily committed to a hospital's mental health facility that night, but hospital officials said Amy's issues weren't serious enough to qualify her for admission.

That was Feb. 13.

Sixteen days later, Amy got the wish that she had texted to her mother.

She was dead.

Telling Amy's story

Kay said she has been telling Amy's story to mental health advocates in an attempt to prompt legislative changes that would have allowed Kay to have Amy involuntarily committed and given Kay access to her daughter's mental health information.

"This is kind of embarrassing to share, but there's so many people in this situation and if I can make a difference to one person, that's worth it," said Kay, who has become involved in advocacy efforts at the Greater Reading Mental Health Alliance, an affiliate of the National Alliance on Mental Illness. "I have met so many of these poor, poor people. Somebody has to help them."

Legislative changes to mental health regulations at both the state and federal levels have been proposed and passionately debated since the Dec. 14, 2012, massacre at Sandy Hook Elementary School in Newtown, Conn.

In December 2013, the Joint State Government Commission issued a 295-page report with 44 recommendations on preventing violence and dealing with mental illness.

The Senate report was called for by state Sen. Stewart Greenleaf, a Montgomery County Republican. A similar report by the same commission called for by state Rep. Thomas R. Caltagirone, a Reading Democrat, is due in May.

Greenleaf has yet to craft legislation from the Senate report, which he is still reviewing, though he has proposed other mental health bills.

One would provide mental health treatment for prison inmates and the other would help doctors and family members place mentally ill patients into outpatient treatment programs.

"Overall, much is happening in the Legislature to better address mental illness and help people receive treatment," Greenleaf said. "I think as more legislators become educated about this issue, we will see these bills move forward and more activity generated from the Joint State Government Commission reports."

Some mental health groups have opposed various portions of proposed laws, chiefly over worries about stripping away patients' privacy and forcing people into unwanted treatment.

Accidental death

Amy suffered from several mental health problems, such as depression and borderline personality disorder. The disorder is marked by erratic moods, unstable relationships and impulsive and reckless behavior, according to the National Institute of Mental Health.

Amy had been seeing a psychiatrist and a psychologist for seven years, but she didn't share with her mother what she talked about during those visits. Kay offered to attend a session, but Amy never took her up on it.

Amy underwent several attempts at rehabilitation for a rotating array of addictions.

Her most recent demon came in the form of cans of spray cleaner.

A chemical in the cleaner, compressed difluoroethane, can be abused as an inhalant to induce euphoria, according to the National Center for Biotechnology Information at the U.S. National Library of Medicine, Bethesda, Md.

Inside her apartment the night of Feb. 13, police and Kay found numerous trash bags packed with empty canisters of the spray cleaner.

On Feb. 28, Kay texted Amy to see how she was doing.

She didn't get a reply, but she was trying to give Amy some space.

On Saturday morning, March 1, Amy still hadn't replied and Kay's worry turned to fear. She went over to Amy's apartment.

Amy's landlady saw Kay and told her Amy wasn't answering her door.

The landlady said she was about to open Amy's apartment because the young woman had left her car in the landlady's parking space.

The landlady asked Kay if she'd like to go inside the apartment to check on her daughter instead of having the landlady go inside.

"I had this gut feeling," Kay recalled. "I said, 'No.' "

The landlady went inside and quickly re-emerged, saying Amy wasn't breathing.

They called 9-1-1 and police and paramedics soon arrived.

It wasn't long before the Berks County coroner's office did, too.

"These people with mental health problems, we have to be able to help them more," Kay said.

After conducting toxicology tests, the coroner's office ruled Amy's death accidental and said the cause was cardiac arrest induced by abuse of difluoroethane.

Though Kay agrees with the ruling that the death was accidental and not suicide, she feels her daughter's text about wanting to die wasn't taken seriously by medical professionals.

"You know what? Read her obituary," Kay said. "Now you can take it seriously. It boggles my mind that you can text somebody that you want to die and nobody can do anything."

A delicate balance

For years, Kay supported her daughter financially, paying for her car and apartment.

"She couldn't keep a job," Kay said.

As she sat on a couch in her Spring Township town house recently, Kay said she finds it difficult to accept that she was supporting Amy financially and yet had no right to information regarding her mental health treatment or addictions.

Sitting in a nearby chair, Deborah Manderewicz, Kay's roommate and a bereavement coordinator, noted there is a delicate balance between privacy and granting access to crucial medical information.

"If the mentally ill aren't making good decisions, their caregivers and family members need to be allowed to somehow be a part of care decisions," Deborah said.

Kay said she wishes those who were treating Amy's mental illnesses knew how close she was with her daughter.

"They should have picked up the phone and called me," Kay said.

"But the law says they can't," Deborah replied. "If a patient opens up and tells their story, they have to be comfortable there will be some confidentiality there. But where is the line? If they are a clear and present danger to themselves or others, that's where HIPAA ends."

HIPAA, the Health Insurance Portability and Accountability Act of 1996, allows some privacy exceptions if a person is legally authorized to make health decisions for a patient or if disclosure is an effort to avert a serious and imminent threat to public safety.

Kay and Deborah sat in silence for a moment.

"Would anything that could have been done have made a difference," Deborah began slowly, "or would it have only delayed the inevitable?"

"I don't know," Kay replied.

"And you can never know," Deborah said.

Contact Jason Brudereck: 610-371-5044 or [email protected].

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