BALTIMORE — Samantha Hart hardly recognized her father when she picked him up at the Baltimore County jail.
Henry Hart, who days earlier had been joking and dancing at a family gathering, was slumped over in a wheelchair. The 76-year-old had lost weight, his knees and elbows were bruised, and his right hand was purple and swollen. But what concerned Samantha most was that three days after her 911 call led to her father’s arrest, he didn’t recognize her or his wife of 57 years, Rosalind.
Like thousands of seniors in Maryland, Hart is experiencing cognitive decline — a condition that often causes people to behave in unusual and sometimes aggressive ways. As Maryland’s population ages, experts fear that police will encounter people with dementia more often and without recognizing the condition or knowing how to respond to it. Arrest or jail time can be especially harmful to people with dementia, given their mental and physical vulnerability, experts say.
After Hart’s stint in the detention center, his family said his cognitive ability degraded sharply. Before his arrest, he’d forget where dishes and utensils were kept and had once gotten lost on a drive, but afterward, he struggled to walk. He seemed confused most of the time, and did and said things that didn’t make sense.
Then, two months after his incarceration, his family took him to a hospital emergency department after he could no longer move his left leg. Doctors determined July 3 that he had a brain bleed likely caused by a head injury, and that signs of the bleed could be seen on a CT scan Hart received right after his jail stay, his family said.
Police arrested Hart after Samantha called 911 on May 1 after he became agitated and hit her. She said she told the operator he was experiencing a mental breakdown and asked paramedics to take him to a hospital. Baltimore County Fire dispatched an emergency medical services unit at 8:22 p.m., but the call was canceled en route, spokesperson Elise Armacost said. She didn’t know why the EMS response was canceled, saying it was not part of the record.
Only Baltimore County Police came to the door. In charging documents, they said Hart “appeared to be intoxicated” and “was very excited.” Although Samantha said she and her mother told officers that her father had dementia — they also acknowledged he had been drinking — the charging documents don’t mention Hart’s cognitive impairment. When the officers began to leave, the documents said, Samantha asked them to stay, worried the situation would escalate again.
As the officers and Samantha stood on her front porch, they watched Hart grab Rosalind and try to push her out the door. Even though Rosalind and Samantha said they asked the officers not to, they handcuffed Hart and arrested him for second-degree assault.
“Rosalind, come get these things off of me,” Samantha and Rosalind recalled Hart said as the officers arrested him. “Why are they touching me? I didn’t do nothing.”
A looming crisis
With the number of elderly Americans ballooning, doctors and researchers are anticipating a public health tsunami that they say the country is ill-prepared for: a growing population of people with dementia — a loss of ability to make decisions, remember and think that interferes with everyday life.
About 1 in 9 people in the U.S. who are 65 and older have Alzheimer’s disease, the most common cause of dementia, according to the latest figures from the Alzheimer’s Association. By 2025, the number of people with Alzheimer’s in Maryland is expected to rise to more than 130,000, an increase of nearly 20% since 2020. Older African Americans like Hart are twice as likely to have dementia as white people, according to the U.S. Centers for Disease Control and Prevention. Hispanics are 1.5 times more likely.
Experts say the graying population means police officers may increasingly come in contact with people behaving in aggressive or unusual ways because of neurocognitive impairments.
While there’s no national count of how many people with dementia are arrested each year, according to The Marshall Project, a national news organization focused on criminal justice, arrests for people 65 and older increased nationwide before the pandemic. In Maryland, arrests for older people grew 47% between 2015 and 2019, while overall arrests rose 9.5%, according to FBI data. In Baltimore County, people 65 and older made up about 1% of people arrested in 2022.
In recent years, police elsewhere have injured or killed seniors with dementia.
In May, a former Colorado police officer was sentenced to five years in prison after he roughly arrested a 73-year-old woman with dementia in 2020, dislocating her shoulder and fracturing her arm. The woman allegedly had walked out of Walmart without paying for about $14 in merchandise. In New Mexico last year, an officer fatally shot a 75-year-old woman who had dementia as she stood holding two large kitchen knives in the doorway of her home.
There is a critical need to train more people — including caregivers and hospital workers, as well as police officers and those who work in jails and prisons — about how dementia affects a person’s behavior, experts say.
‘He didn’t need to go to jail’
Although Baltimore County Police does not have a specific policy related to dementia, spokeswoman Joy Stewart wrote in an email, new officers get training on mental illness and cognitive decline in the police academy. Groups like the Alzheimer’s Association provide additional training to officers certified in crisis intervention. The department also offers in-service training scenarios involving drivers with dementia, Stewart said.
While patrol officers are not required to call the county’s mobile crisis team, which pairs a trained officer with a mental health clinician, the department’s field manual tells officers to request the team’s response “if the subject is believed to be experiencing mental health related issues.”
Baltimore County Police denied a Maryland Public Information Act request for officers’ body-worn camera footage of the May arrest, citing an open administration investigation. The Baltimore County 911 Center also cited an open investigation when it denied a request for a recording of the 911 call; it did not immediately respond to questions about the canceled EMS unit.
Stewart declined to discuss the family’s information that they told responding police officers about Hart’s dementia, citing privacy laws and the open investigation. She wouldn’t say whether the responding officers were certified in crisis intervention, writing that officer certifications are personnel records protected from disclosure under Maryland law.
When asked about whether Hart sustained a head injury during his arrest, police spokesperson Trae Corbin referred reporters to a police report in which police indicated they did not use force in the arrest. The report categorized the situation as “domestic violence” and did not mention dementia or other health conditions.
When Samantha picked her father up from the county jail in May, she immediately drove him to Sinai Hospital in Baltimore, where he was treated for four days.
There, according to his medical records, doctors diagnosed him with a boxer’s fracture, a broken bone that usually results from direct impact to a fist, on his hand and an “altered mental status,” a condition that can be a sign of dementia, psychosis or delirium. He was dehydrated and in withdrawal from alcohol. He also was missing his top dentures.
Erica Palmisano, a Baltimore County spokeswoman, declined to say what medical treatment Henry Hart received at the jail, citing privacy laws. But she said he was housed under close observation in a “single-cell medical housing unit.” Palmisano said the jail had no record of staff using force or a responding to an emergency involving him during Hart’s detention. She said any records from his incarceration will be reviewed as part of the police department’s open administrative investigation.
“He didn’t need to go to jail,” Samantha said.
The family filed a complaint with the police department because the officers arrested Hart after his relatives told them they didn’t want that to happen.
After a county district judge in June found Hart to incompetent to assist in his own defense and a danger to himself and others because of his alcoholism, based on a court psychiatrist’s report, he was sent back to jail to wait for a bed in a state psychiatric hospital. That day, when his family spoke to him on the phone, he seemed confused about where he was.
“Please come get me,” Samantha said he kept saying. “I’m ready to go now.”
Changing considerations
Many people with dementia become easily agitated and paranoid because they’re experiencing a slow degeneration of their brains, said Dr. Peter Crino, chair of the University of Maryland School of Medicine’s department of neurology and the chief of neurology at the University of Maryland Medical Center.
When they’re upset, they can respond in primal, visceral ways — potentially lashing out at caregivers.
It’s also common for people with dementia to wander by foot or car. Police may encounter people experiencing cognitive decline after pulling them over for erratic driving or responding to shoplifting or indecent exposure, said Megeen White, a registered nurse who serves as program manager for the Alzheimer’s Association Greater Maryland Chapter.
The local branch of the national organization has helped train first responders in the area since at least 2009, White said. Along with assisting in crisis intervention training in Baltimore and Harford counties, the group also helps train Harford County firefighters and Howard County emergency medical technicians, among other emergency responders.
During the training — which White said the group offers about three times per year in Baltimore County — first responders learn how to identify someone who might have dementia and how to interact with them. Facilitators use the acronym TALK: Take it slow, Ask simple questions, Limit reality checks and Keep eye contact.
While officers may encounter a variety of scenarios — including elderly people brandishing weapons — and have to adjust their responses accordingly, Crino said it’s important that police be aware of how dementia could be affecting seniors’ actions.
Officers could ask a caregiver about the senior’s medical issues and potentially call in medical professionals, who could sedate or comfortably restrain them.
In recent years, more attention has been paid to how law enforcement should respond to people with mental illnesses and developmental or intellectual disabilities because of high-profile cases, said Luciene Parsley, an attorney for Disability Rights Maryland.
Some Baltimore-area agencies partner with mental health providers, who take emergency calls or respond alongside officers or deputies. In Baltimore County, clinicians field some 911 calls and accompany the police department’s crisis team.
Long road to recovery
Although there isn’t much research on how incarceration or police interactions affect people with dementia, a drastic change of environment can have a lasting impact on a patient’s cognitive function, said Dr. Mark Gloth, the chief medical officer at Gilchrist. Even a 24-hour hospital stay can prompt cognitive decline, studies show.
While it’s “not unreasonable” to assume the same would hold true of jail, Gloth said, more research is needed to say that with certainty.
After Hart returned from court to jail in June, Baltimore County Assistant State’s Attorney Michelle Fuller filed a motion to drop the charges against the senior and release him immediately. Prosecutors wrote in the motion that Samantha and Rosalind didn’t want to pursue charges against Hart and weren’t injured when he allegedly pushed them.
The motion also quoted the court psychiatrist’s report, which found Hart’s “risk would be reduced if he remains abstinent from alcohol.” Samantha told prosecutors he had not had a drink since his arrest.
Fuller first spoke to Samantha and Rosalind after the competency hearing, which Fuller attended remotely, she said in a June 23 interview with The Sun.
“Once they called me afterward and I talked to them, I felt comfortable not proceeding with the case based on what they told me,” Fuller said. “I felt like the best thing for him was to not be in the detention center.”
As a result of Hart’s case, Fuller said District Court Administrative Judge Dorothy Wilson has asked county prosecutors to appear in person for mental health hearings, which are held twice a month in the Towson court, and Baltimore County State’s Attorney Scott Shellenberger said Wednesday that his staff now does this.
Meanwhile, Hart is recovering from brain surgery he underwent earlier this month to address the bleed. Samantha said the system failed her father, who will now require 24/7 care once he is able to go home.
“I would rather call my brother and tell him to come from New York, quick as he could,” she said, “before I would call 911 paramedics again.”
