Monica Rittel was mentally ill and a heavy drug user. She’d been in and out of San Diego County's jail and mental health system, along with private rehab programs for more than a decade. And she died a gruesome death just hours after her most recent release from the County Psychiatric Hospital.
Monica’s mother, Sylvia Castelluzzo, remembers her eldest child as healthy and smart as a whip. “A great baby,” Sylvia recalled. “Fun, happy, and gifted in everything. Her teachers were grooming her for great things.”
But Monica’s parents said all that changed, seemingly overnight. “We lost her right about the time she turned 16,” Sylvia said. “She became like a stranger.”
Monica’s parents said she started using methamphetamine and other drugs, got involved with a much older man, shaved her head, and acted erratically.
One day, she shattered every mirror in the family home.
From then on, Monica was in and out of jail and treatment programs for mental illness and drug addiction. "We just lost her to this illness,” Sylvia said. “The hospitals didn't help, the rehabs didn't help, the jails didn't help. Nothing helped."
Last November, just days before Thanksgiving, sheriff's deputies told Sylvia they found Monica naked, on a busy street in Santee.
"She was running into traffic, trying to kill herself," her mother said.
The deputies took Monica to the County Psychiatric Hospital, where doctors placed her on a 72-hour involuntary hold. According to her mother, Monica had been in and out of that public hospital several times that year. Sylvia told NBC 7 Investigates she believes hospital staff should have known how unstable she was.
“She was a danger to herself,” Sylvia said. “She wasn't in her right mind. She couldn't make rational decisions."
Monica’s parents saved a voice-mail message they got from Monica just hours before she was released from the psychiatric hospital. In a flat, monotone, speaking of herself at times in the third person, she told Sylvia, “Mom, you tell dad, you tell yourself, you tell whoever, it's Monica at CMH. All you gotta do is call the nursing station and tell them, when do you plan on picking her up? She has no shoes on."
Sylvia said she was sure Monica would be held at least 72 hours, as allowed by state law.
"I didn't know they were going to let her out the next day, and that she was going to use meth that was laced with fentanyl."
An autopsy report obtained by NBC 7 Investigates confirms that's what happened.
Just hours after she was discharged from the hospital, paramedics found Monica unconscious, in a homeless camp not far from the hospital.
She died two days later, of a fentanyl and methamphetamine overdose. She was 34 years old.
Just weeks before the one-year anniversary of her death, Monica’s parents filed a wrongful death and medical malpractice lawsuit against the county and its Psychiatric Hospital.
That lawsuit alleges county employees were negligent in their care and treatment of Monica, and “... improperly discharged (her) while (she) was still a danger to herself.”
"This was not a reasonable judgment by the county,” said Elliott Kanter, the family’s attorney. “They knew she had a drug history. They knew she was a danger to herself.”
A county spokesperson would not respond to those criticisms or the family's lawsuit.
But one mental health expert told NBC 7 Investigates it could be a difficult task to convince a jury that county employees were negligent and responsible for Monica’s death.
"It’s a judgment call,” said Dr. Clark Smith, a psychiatrist and expert witness in civil and criminal lawsuits. “If (a patient) appears reasonable and rational and they convince a doctor that they're no longer a danger (to themselves or others), they can be released.”
But Dr. Smith also said Monica's troubled life and untimely death highlight very serious shortcomings with the treatment and rehabilitation of San Diego’s mentally ill and drug addicted.
"It is a horrible problem,” Smith said. “The system is broken, because so many of these patients end up in a revolving door, in and out of jail without ever getting definitive treatment."
Dr. Smith argues that the cost of effective long-term care is less than taxpayers spend to transport, treat, hospitalize and incarcerate the chronically mentally ill and drug addicted.
"But even if we wouldn't save money, it's the right thing to do," Smith said.
Monica’s parents agree. "I would like to see a little more empathy for the mentally ill and drug addicted,” Sylvia said. “A lot more structure, and a lot more follow-up."
In October, the county promised to devote more money and resources for treatment of the mentally ill. Those expanded programs could include better crisis care and a significant increase in the number of beds at the County Psychiatric Hospital.