In the hours after his arrest for allegedly killing his mother and setting her body on fire outside her Truro home, Adam T. Howe was taken to Cape Cod Hospital, where a doctor who treated him was clear: Howe needed to be sent to a secure psychiatric facility.
Around 3 a.m. on Saturday, an on-call judge agreed, ordering Howe to be involuntarily committed to Bridgewater State Hospital, a state facility for men with mental illness, under a law known as Section 12, according to Michael O’Keefe, the district attorney for Cape Cod and the Islands.
“That’s the purpose of Bridgewater,” said O’Keefe, whose office was in charge of Howe’s prosecution. “People like this.”
But staff at Bridgewater, which is used to treat sentenced prisoners with mental illness and those whose fitness to stand trial is in doubt, refused to comply with the judge’s order, according to O’Keefe. Instead, the facility said such a request would have to come from a jail under a different law, known as Section 18.
As a result, the 34-year-old Howe, who doctors and police warned was displaying “suicidal ideation,” was sent to a jail in New Bedford, in a county with a troubling history of keeping its inmates safe. His body was discovered Sunday afternoon following what officials say was a suicide.
The death raises troubling questions about how a man with a well-documented history of mental illness — and accused of an unspeakable crime — was denied specialized care for more than a day, despite protests from the prosecutor overseeing his case. It left some wondering whether bureaucratic lapses and inertia were to blame, while bringing renewed attention to Bristol County Sheriff Thomas M. Hodgson’s office, which operates the New Bedford jail.
The inability to admit Howe to Bridgewater immediately, O’Keefe said, shows that “the system is broken, not only in the criminal justice milieu but for people with mental health issues who do not commit crimes.”
Susan Howe was a beloved figure in Truro who served as board president for the town’s historical society. As loved ones grappled with her death as well as that of her son, state officials remained largely silent.
In a statement Monday evening, a spokesman for the state Department of Correction, which oversees the Bridgewater facility, said “there are protocols for emergency psychiatric hospitalizations determined by law, and the Department of Correction follows these procedures for commitments at all facilities, including Bridgewater State Hospital.”
The Section 12 law does not apply to the hospital, the agency said, because it deals only with civil commitments. The hospital “accepts the responsibility of care and custody of all males” committed under Sections 15 and 18 of state law, it said.
But O’Keefe and others questioned the handling of events leading up to Adam T. Howe’s death in jail. After staff at Bridgewater said they would not accept Howe, he was released into State Police custody, O’Keefe said. They contacted the Barnstable County Sheriff’s Department but “couldn’t get a hold of anyone,” O’Keefe said.
State Police contacted the Bristol sheriff’s office, which said Howe could be held at the Ash Street Jail in New Bedford. There he was placed on a security watch “in which a corrections officer would visually check on him every 15 minutes,” said Jonathan Darling, a spokesman for Hodgson.
But in between officer rounds, Howe “clogged his airways with wet toilet paper and suffered a medical emergency,’’ Hodgson’s office said. He was taken to St. Luke’s Hospital, where he was pronounced dead.
Though the state medical examiner will conduct an autopsy, officials said, foul play is not suspected.
Given his status, Howe should have been placed under constant observation, rather than a 15-minute visual check, said James Pingeon, litigation director for Prisoners’ Legal Services of Massachusetts.
The New Bedford jail “is not a place for someone with significant mental illness,” he said, noting that Bristol County correctional facilities have historically had “a higher number of suicides than any other county in the state.”
In 2018, the New England Center for Investigative Reporting found that at least 16 people died from suicide between 2006 and 2017 while in the custody of the Bristol County House of Correction.
More than a quarter of all suicides in the state’s 13 county jails had occurred in Bristol County in the preceding six years, the review found, despite Bristol County accounting for just 13 percent of inmates.
“The fact that this keeps happening and happening and happening, this is extraordinary,” said Mark Itzkowitz, a lawyer representing the family of a 28-year-old woman who took her own life in a Bristol County detention facility in 2014. “Why they had him on 15-minute checks is a very good question for whoever is going to get this case down the pike.”
Pingeon said the judge who approved O’Keefe’s request under Section 12 could have done the same under Section 18. Officials at the jail could also have petitioned to have Howe admitted to Bridgewater under Section 18, he said.
“Whatever the technical obstacles,” Pingeon said, “they were not insurmountable.”
Howe attended Belmont High School, where he was a captain of the school’s wrestling team and was involved in theater, according to John Mosley, who graduated with Howe in 2006 and also knew Howe’s mother, he said.
“Nice kid, never any real problems,” said Mosley, 34. “Obviously, this comes as a huge shock.”
In May 2021, Howe was charged with attempted sexual assault against his wife, first-degree aggravated domestic assault, and first-degree unlawful restraint, Vermont court records show.
Howe pleaded not guilty, and the case was still pending at the time of his death.
In the aftermath of the 2021 charges, Howe was released into his mother’s custody until he could be admitted for in-patient treatment at a treatment center in Bourne, according to court records. He was ordered to have no contact with his wife, except for matters concerning the couple’s young daughter, and was required to alert his lawyer if he was released from the hospital; the attorney, in turn, was required to alert the state, according to court records.
Their 2-year-old daughter is being cared for by her maternal grandmother, according to John DiPiano, the grandmother’s lawyer in a separate Massachusetts case. The woman “is in the process of processing this loss,” DiPiano said.
“Her focus has always been, and continues to be, on the well-being of her granddaughter. This is a situation [that] illustrates that we as a society need to augment our mental health care system and substance abuse recovery system.”
The domestic charges against Howe followed about a half-dozen incidents over the previous months at the couple’s home in Manchester, Vt., according to police Lieutenant James Blanchard.
In November 2020, officers spent about an hour talking to Howe at his home while he held a knife to his throat and threatened to commit suicide, according to a police report. Howe’s father and wife also urged Howe not to harm himself.
Howe eventually dropped the knife, although he refused to go to a hospital in an ambulance. Officers placed him in handcuffs and took him to the Rutland Regional Medical Center’s emergency room, police said.
In an interview, Howe’s father, Jeff, said the family has turned to one another for emotional support as they grieve. Though he and Susan Howe had divorced about seven years ago, he said, the two had remained friends.
“The only thing I’d say is that it’s an end to a very sad couple of days,” he said.
Felice J. Freyer of the Globe staff contributed to this report.