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An early morning phone call, a tragic decision by DOC

Adam Howe’s life ends in an avoidable chain of events that should prompt multiple probes.

Bridgewater State Hospital refused to admit Adam T. Howe.JohnTlumacki

Adam T. Howe is dead — a victim not just of the mental illness that eventually claimed his life but of a tragic set of circumstances that demand investigation.

From the bureaucrat at Bridgewater State Hospital who refused to admit Howe to the state’s most secure facility for mentally ill prisoners, to those in charge of the county jail with the worst reputation in the state for jail suicides, there are plenty of questions to go around about a death that should have been prevented.

In fact, if the mental health system — both inside the criminal justice umbrella and outside it — really worked here, it could have saved two lives: that of Howe, who died in an apparent suicide in a jail cell Sunday, and that of his mother, whom Howe was accused of killing on Friday.


“The system is broken, not only in the criminal justice milieu but for people with mental health issues who do not commit crimes,” Michael O’Keefe, district attorney for the Cape and Islands, told the Globe.

The problem of emergency room “boarding” of people in mental health crisis — patients stuck because there are no available treatment beds — is, as O’Keefe said, all too real in both worlds.

The 34-year-old Howe’s mental health issues dated back to at least 2020. By 2021, court records show, he was released to his mother’s custody while awaiting admission to an in-patient treatment center in Bourne.

Howe was charged with killing 69-year-old Susan Howe on Friday and setting her body on fire on the front lawn of her Truro home. Police took him into custody and then to Cape Cod Hospital where doctors warned that Howe was displaying “suicidal ideation.”

By 3 a.m. Saturday an on-call emergency judge, after listening to the doctor in charge of the emergency room and to the district attorney, ordered Howe to be involuntarily committed to Bridgewater, a facility run by the Department of Correction.


But the judge issued her order citing Section 12, which relates to civil commitments, rather than Section 15, which allows defendants in criminal cases to be hospitalized at Bridgewater for observation and evaluation for up to 20 days, or Section 18, which covers those already detained by a facility and in need of hospitalization for mental illness for up to 6 months.

O’Keefe told the Globe editorial board that a man who identified himself as the “supervisor on” at Bridgewater insisted “we don’t take 12s, we take 18s.”

“We talked to him several times,” O’Keefe added. “I talked to him twice. The judge was willing to talk to him directly. All we wanted was to put this guy in [Bridgewater] until his arraignment Monday.”

At that point a court clinician would see him and order him in for an evaluation.

A spokesman for DOC said in a statement, “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.”

Meanwhile, as O’Keefe described it, Howe is “shackled to a gurney” at the Cape hospital while State Police look for another option.

Barnstable County would have been the logical choice, but O’Keefe said State Police “couldn’t get ahold of anyone” in the Barnstable County Sheriff’s Department.


The Bristol County Sheriff’s office offered up the Ash Street Jail in New Bedford, where, according to a spokesman for Sheriff Thomas Hodgson, Howe was placed on a security watch and checked on by a correction officer every 15 minutes. On Sunday afternoon, Howe was found dead in his cell, his airways clogged with wet toilet paper.

According to a 2018 New England Center for Investigative Reporting investigation, at least 14 men and women died by suicide in the Bristol County House of Correction between 2006 and 2016. Two more men died by suicide in 2017. And while Bristol County accounts for only 13 percent of all inmates housed in 13 county correction facilities, it accounted for more than a quarter of all suicides.

A number of lawsuits are already pending against the sheriff’s department, filed by families of those who died by suicide while in custody.

Hodgson’s track record, Howe’s apparent suicide included, deserves far more official scrutiny than it has gotten to date.

But then Howe didn’t belong there in the first place. He belonged at Bridgewater, a medium-security facility — one where clinical services are provided by Wellpath, a private, for-profit company under contract to the state.

And that raises the question of who actually said “no” to the judge and to O’Keefe in the middle of the night? Who refused to negotiate? And how far up the chain of command did the request go?

Ultimately the case provides powerful fodder for advocates who have long wanted Bridgewater taken away from DOC and turned over to the Department of Mental Health for a more humane approach to care.


A frustrated O’Keefe said, “I mean at 3 o’clock in the morning it seems to me they could have taken this guy in for three days” — days that might have made the difference between life and death.

As for violating “protocol,” the DA turned to the wisdom of Charles Dickens, adding, “Sometimes the law is an ass.” We don’t disagree.

Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.