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In first Md. suit of its kind, woman who killed her sons blames HMO, doctors

THE BALTIMORE SUN

She acknowledged later to the psychologist that it didn't seem to make sense, buying more diapers for her infant son so close to the end. But, Annamaria Angel Rescott explained, she had wanted her two boys to be as comfortable as possible on the last day of their lives.

She loved them.

She watched cartoons with them and played with them and finally kissed them goodbye in that Holiday Inn motel room four autumns ago. Then, one after the other, she suffocated them with motel pillows.

Mrs. Rescott was found to be insane, the victim of postpartum depression, paranoia and delusions. In the legal parlance of the day, she was "not criminally responsible" for this most horrifying of all transgressions.

With that finding, the anguishing tale of Mrs. Rescott might have slipped from public memory. But instead, from the moment she stepped into Clifton T. Perkins, the state's hospital for the criminally insane, Mrs. Rescott began asking a troubling question, one that may soon reverberate far beyond the boundaries of her life:

If she was not responsible for the deaths of 7-year-old Brandon and his infant brother, Corey, who was?

Her answer, contained in a lawsuit, is the medical providers who had treated her.

Their "negligence, omissions [and] actions," Mrs. Rescott claims, were the "direct" cause of the awful events in that Cumberland motel. Their devotion to the bottom line rather than to her recovery from depression cost her children their lives, she alleges.

The defendants in the lawsuit are Columbia Freestate and three internists who treated Mrs. Rescott for the health maintenance organization (HMO); University Hospital and three psychiatrists who cared for her there; and Terry Bauknight, the psychologist who began seeing Mrs. Rescott soon after Corey's birth.

Neither Dr. Bauknight nor his lawyers returned repeated telephone calls from The Sun. Through spokesmen, the other defendants refused to comment except to deny the lawsuit's allegations that they were liable for the deaths of the boys. All are seeking dismissal of the lawsuit.

Those who treat the mentally ill sometimes have been held liable for the violent actions of their patients. But this case appears to be the first in Maryland in which a criminally insane patient has attributed killings to medical malpractice.

What may be more significant is the lawsuit's indictment of a health care system that Mrs. Rescott charges places medical treatment secondary to profit.

It is an allegation frequently leveled at HMOs, and particularly in regard to mental health services. While unaware of the Rescott lawsuit, many believe that in an effort to contain costs, good medicine is compromised.

"Too often, there's just an effort to save money by discharging patients from hospitals when they still need ongoing care and there's no alternative outside the hospital," said Steven Sharfstein, president and medical director of Sheppard and Enoch Pratt Hospital and chairman of an American Psychiatric Association committee that is exploring how decisions are made in health insurance.

Mrs. Rescott's lawsuit argues that she was prematurely discharged from University Hospital in March 1988 and then inappropriately placed primarily under the care of a psychologist who lacked the training to deal with her complicated array of physical and psychiatric conditions.

The result was that Mrs. Rescott steadily deteriorated until finally she was in a motel room, convinced the only way to save her children from a world she regarded as perilous was to smother them, the suit contends.

"The worst part about it, the part that would make me cry about it at night, was seeing that maybe this should never have happened," said Richard Mazza, Mrs. Rescott's older brother.

Tragedy with some warning

The day after his brother Corey's birth, 6-year-old Brandon got a call from the hospital. When he put the phone to his ear, all he heard was the sound of his mother weeping.

A year later, people would wonder whether that call was the tragedy's most advanced warning. It was followed quickly by others. Within days of delivery, it was apparent that Anna Rescott was not herself.

A strong, warm and outgoing woman of 30 who was healthy and full of energy during her second pregnancy, Mrs. Rescott was withdrawn and lethargic after delivery. She didn't want to be around others and had difficulty talking to people. Her Catonsville neighbors noticed that she kept her blinds pulled down during the day.

Her husband, Mark, a mechanic, later told doctors of more dismaying behavior. She stopped bathing and keeping house. She barely prepared for Christmas, and her treatment toward the children was veering toward the bizarre. She refused to put Corey down from morning to night, and she kept Brandon out of school for weeks at a time, fearful that someone would hurt him if he ventured from her.

Mr. Rescott didn't know all. After the killings, his wife revealed that she had become obsessed with thoughts of suicide within weeks of Corey's birth. She began carrying a kitchen knife, so she would be ready to slit her wrists when the urge became irresistible.

Mrs. Rescott said she also began fantasizing about killing the children, fearful that with her gone -- dead -- no one could protect them. She said that on occasion she put her hands around their necks but could not bring herself to choke them.

After Mrs. Rescott barricaded herself in her home in February 1988, her family rushed her to see Dr. Bauknight, a specialist in family therapy.

His diagnosis was alarming: major depression with possible psychosis -- delusions. He recommended immediate hospitalization.

At University Hospital, her psychiatrists -- Charles Hicks, Steven Crawford and Joseph Liberto -- put her on anti-depressant and, briefly, anti-psychotic medication. Because her cancerous thyroid was removed when she was 17, she continued taking drugs to prevent hypothyroidism, a condition associated with lethargy, agitation and depression.

After a month, she was discharged.

Under Freestate's arrangement, she was placed under the medical supervision of three internists at Freestate's Catonsville-Wilkens Medical Clinic -- Victor Roth, Bernita Taylor and Lawrence Kay.

After the discharge

For therapy and family counseling, she and her family were referred to Dr. Bauknight, a psychologist. Psychologists are not medical doctors; they are not trained to assess or treat a patient's physical condition or to prescribe medications.

Mrs. Rescott's lawsuit contends that her medical treatment "failed to meet the standard of care for psychiatric services."

The case, which has been brought by Mrs. Rescott, her former husband, Mark, and the estates of their children, will be decided by a three-member panel appointed by the Maryland Health Claims Arbitration Office. The decision could then be appealed to the courts.

Neither Mrs. Rescott, who must remain at Perkins until a judge determines she is no longer dangerous, nor Mr. Rescott, agreed to be interviewed for this story, although their attorneys spoke at length.

Among its other charges, the lawsuit says that Mrs. Rescott was not far enough along in her recovery to be discharged from University. Her lawyers say she was released only because Freestate refused to pay for more than 28 days there. Freestate also refused to pay for the services of an outpatient psychiatrist, the lawyers say.

A month after her discharge from University, Mrs. Rescott returned to its emergency room in distress. According to the lawsuit, there followed a series of "panicked" phone calls among University and Freestate doctors and Dr. Bauknight. At first, all agreed on rehospitalization, but, according to the lawsuit, because Freestate would not pay for another stay and University would not accept her without assurance of insurance coverage, she was not readmitted.

Skimming on care alleged

The lawsuit's most crucial allegation relates to the period that followed. Her lawyers charge that the Freestate doctors essentially allowed Dr. Bauknight to supervise her medical condition and to monitor her blood levels to assure she was on the proper dosages of medication. The psychologist and the Freestate doctors failed to properly analyze lab results or react appropriately to indications that Mrs. Rescott was not taking adequate dosages of medication, the suit alleges.

The defendants in the Rescott case have not yet addressed the medical aspects of the case in their initial briefs. But University and its doctors have pointed out that Mrs. Rescott was discharged eight months before the killings. They say that timing alone relieves them of responsibility.

In seeking dismissal of the lawsuit, all the defendants are arguing that Mrs. Rescott never suggested to any of her care-givers that she thought of killing her children. Absent such warnings, they had no way of foreseeing her actions, they say.

According to Perkins' records, Mrs. Rescott's condition deteriorated through the fall. She could not take care of herself or her children. She stayed in bed. She lost weight. And again, she became consumed with the idea of killing herself and her children.

"She felt she had to die," said a Perkins' report based on an interview with Mrs. Rescott, "and she had to take the children with her -- she couldn't leave them here to be hurt. But, their death had to be painless."

'This was it'

In her later accounts, she said she woke up Oct. 24, 1988, and realized "this was it."

She told her mother, who by then was caring for the children, that she was taking Corey to buy a snowsuit. She then picked Brandon up at school and headed west.

At noon, she missed a scheduled appointment with Dr. Bauknight, who then called Mrs. Rescott's mother. With her still missing two days later, he would warn police that Mrs. Rescott might be dangerous to herself and her children.

She checked into a Holiday Inn in Cumberland. In the next hours, while she fed the boys, bathed them, played and watched television with them, Mrs. Rescott tried to gather herself to kill them. Several times, she made aborted efforts to tie Brandon with rope, but, worried that she'd hurt him, gave up.

Sometime either the next day or the day after, she persuaded Brandon to let her put a pillow over his face. While he struggled, Corey sat on the floor playing with his mother's purse. After Mrs. Rescott smothered Corey on the bed beside Brandon, she noticed that his fingers were curled around some pennies he had snared from her wallet.

With the children dead, Mrs. Rescott quickly moved to take her own life. For days, she had been worried about that period of time when the children would be "on the other side" without her there to comfort them.

Now, she tried desperately to join them. Over the next hours, she slashed herself more than 100 times on the wrists, thighs and neck with a razor blade. When police found her in a motel dining room three days after her departure from Baltimore, she was dazed, weeping and blood-soaked.

Doctors who examined her at a nearby hospital were surprised she was still alive. She had lost as much as half her blood. Some of the cuts on her wrists were to the bone.

As shocking as the killings were, Mrs. Rescott's criminal case was neither complicated nor controversial. The Clifton T. Perkins doctors concluded that Mrs. Rescott's intense depression and delusions had rendered her incapable of controlling her behavior.

Their report cleared the way for a Cumberland judge in March 1989 to find Mrs. Rescott "not criminally responsible."

By then, Mrs. Rescott, who so desperately had yearned for death, was telling her psychologist that she no longer felt suicidal, that she had forgiven herself for the deaths of Brandon and Corey.

"Now I know I was the victim," she told the doctor. "If I had had proper medical care, this wouldn't have happened."

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