by Mallory Moench
For five years, Alexandra Siliezar tried to keep her older brother alive.
Abraham, an insatiable reader and adoring uncle, suffered from post-traumatic stress disorder after serving in the Marines, turning to alcohol to escape. And when the San Francisco resident sustained a brain injury in a street attack in 2015, he developed dementia and seizures.
The siblings spoke almost every day, Alexandra reminding Abraham to eat or to take his medicine. They sat together at church in the Mission. They celebrated holidays at Alexandra’s home, where he would squeeze her daughter in bear hugs. Their phone calls ended with “I love you.”
On nights when she didn’t hear from him, Alexandra would call hospitals, which he cycled through with alarming frequency — and often tried to leave, against doctors’ advice. Alexandra, a mental health therapist, knew he was losing weight from chronic vomiting and missing doctor’s appointments, leaving pill bottles unopened and sometimes eating rotten food.
Alexandra believed her brother couldn’t care for himself. So she asked his doctors to evaluate his mental capacity. She needed a specific document to ask a judge to appoint her as his conservator, giving her the power to make medical decisions for him, even if he was resistant. She believed he didn’t understand how sick he was, an issue echoed by some of his health care providers.
But as time passed, those providers were split over whether Abraham needed a conservatorship. In July 2020, a doctor and a social worker agreed that Abraham needed additional support, but said her brother didn’t qualify for one type of conservatorship, while the other type available might not give Alexandra the help she sought.
“I always told them: When is it going to be bad enough — when he’s dead?” Alexandra said.
In August 2020, Abraham disappeared after leaving his supportive housing unit in downtown San Francisco. A month later, U.S. Park Police found his body. He was in a ravine off a trail at Lands End near the San Francisco Veterans Affairs Medical Center, where he was often treated. He was 56.
Standing in the ravine four months after he disappeared, talking about her brother, Alexandra choked up.
“I wanted to apologize and tell him, ‘I’m sorry I was not there to take care of you when you died,’” she said. “I fought so hard for five years to prevent this.”
There’s no way to know whether conservatorship would have saved her brother. But Alexandra is convinced it would have helped.
Abraham’s plight reveals how challenging and complicated it can be for loved ones to find the best care for people who become mentally impaired. It also highlights an intensifying debate about whether California’s laws on conservatorship, made stricter half a century ago to prevent mass institutionalization, are too narrow.
The issue is particularly fraught in San Francisco, where thousands of people who need treatment for mental illness or addiction are unhoused, and where available services can be limited or expensive. Judges have approved around 1,300 new conservatorships in the city over roughly the past five years.
Critics of conservatorship complain that forcing people into treatment can strip them of their civil rights, and that caregivers too often turn to conservatorships when they should be pursuing less invasive options. California law allows a court-appointed conservator to compel treatment only if someone is “gravely disabled” or cannot care for themselves.
Those concerns have been animated most recently by the fight over pop star Britney Spears, who was conserved for mental health issues. After she argued the arrangement was abusive, a judge suspended her father as conservator. Advocates for reforming conservatorships view that case as an outlier.
Abraham had housing, health insurance, concerned relatives and a team of VA social workers and doctors. Still, Alexandra believes a fractured health care system, insufficient social services and gaps in conservatorship laws failed him. His death, she argues, was avoidable.
Exactly why Abraham died is unknown, as is the reason he
ended up in the ravine, according to the city medical examiner and park
police. Investigators ruled out foul play. (Click to continue reading)
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