When Richard Pender got out of jail on Thursday morning, July 25, he had a few important things to do. He needed to stop by his regular hangout, Capitol Hill's Coffee Messiah, to see friends there like Opus, the owner. There were hugs and back slaps all around: "Good to see you out here," one young pal beamed. He also needed to check in with his probation officer. And lastly, 40-year-old Pender needed to get a new supply of drugs, the same drugs that landed him in jail the last time around. Why, after spending a month in jail, was Pender picking up more of the offending drug? Because his court-appointed mental-health program ordered him to.

As part of his probation from a 2000 assault (he got into a fight at a friend's funeral), Pender has to go to the Community Psychiatric Clinic (CPC), a provider through the Seattle Municipal Court. CPC put him on Topamax (usually an anti-seizure drug) a few months ago to treat his bipolar disorder. But the Topamax made him so sick that he ended up at CPC's office last month, demanding to be taken off the drug. His "outburst" landed him in jail, where he says jail staff kept giving him Topamax. And when he got out of jail, CPC gave him more, despite his pleas to switch drugs.

Pender says the Topamax made him sick from the start: He was convulsing and blacking out, sweating profusely, and vomiting.

"Whatever this drug was supposed to do, it was not doing for me," he says, sitting at a table outside of Coffee Messiah the day after he got out of jail, nervously twisting his short red goatee. Pender--a.k.a. performance artist Ricky Rebel--is usually upbeat and cracking jokes (he's known for weekly Coffee Messiah open mics and wacky stunts like mocking a performance of Limp Bizkit's Fred Durst ["Monday, Bloody Monday," Amy Jenniges, January 24]). Today, he's quiet and prone to tears.

He suspects his illnesses over the past few months were due to a drug interaction with Topamax and one of the medications he already takes. Pender, a short skinny guy, has AIDS, and takes loads of drugs to stay healthy. He carries a pill case that's overflowing with the multiple tablets he must take daily, like the triple drug cocktail Trizivir. The little yellow 100 mg Topamax pills barely fit into the plastic compartments.

He called CPC in mid June, hoping his caseworker would allow him to switch medications. But despite several phone calls and visits, CPC kept him on Topamax. (If he simply stopped taking the medication, he could have sudden seizures.) And his problems were getting worse: A rash was developing across his face.

On June 16, in a bout of frustration, Pender jabbed a knife into his arm. Bleeding, he went down to the clinic to ask for help. "I'm suicidal and I need to talk to my [caseworker]," he told someone behind the glass-enclosed front desk at CPC. Pender says they told him the caseworker was not in, handed him a suicide hotline card, and sent him away. "I flipped out," he says.

The next day, his probation officer called and told him to report to the police. Apparently, Pender violated his probation by going to CPC and yelling at the staff. Because of the alleged threats, Pender--who couldn't afford bail--had to wait in jail for a hearing.

At the King County Jail, the medical staff gave him more Topamax, and Pender got increasingly ill. Although Pender's HIV doctor, Michael Rosenfield, says the jail medic "wasn't cooperating with me at all" when he called, Rosenfield understood the jail couldn't cater to every inmate's medication demands. "[Pender] was caught in the middle of a lot of red tape," says Rosenfield, who had no jurisdiction over Pender's psychiatric drugs. On July 13, about two weeks after he went to jail, he had a seizure in the cell.

He says the seizure caused a ruckus, and King County put him in solitary confinement for 48 hours. He also refused to take any more Topamax. In jail, he was switched to Zyprexa, but says he continued to have small seizures and blackouts every few days (even after his release).

"[Pender] has suffered irreversible brain damage as a result of cruel treatment and increased amounts of Topamax," his friend Lori Mahieu wrote in an emotional letter she sent to the ACLU and the mayor.

On Thursday, July 25, Pender was released from jail. The next day, he checked in with CPC as required, and they put him back on Topamax. "I'm really confused," he says, holding up a few yellow pills for emphasis. "I'm still getting this drug."

While the drug-interaction warnings for Topamax don't list Pender's other drugs, some of his problems--like the rash and vomiting--are listed as rare side effects.

King County Jail could not comment on the medical issues Pender had while incarcerated. CPC also refused to comment.

amy@thestranger.com

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