Lys Says: This whole story was so traumatic, Malene still lives with the trauma
The Night They Almost Killed Me
By Malene Comes | Between Trust and Trauma
How I Got There
I did not walk into PAC voluntarily.
I was placed on a Title 36 psychiatric hold — Arizona’s involuntary commitment statute — initiated by my former therapist, a 40-year veteran of the behavioral health industry employed by The Guidance Center. She initiated that hold based solely on the fact that I had stated I felt suicidal. She did not conduct a formal assessment. She did not evaluate the nature, context, or severity of what I had said. I said the words. She called it in.
Several months later, she received a letter of concern from her licensing board. And several months after that, she retired.
I note that without further comment.
Under Arizona law, a Title 36 hold sends you to whatever facility holds the regional contract for involuntary psychiatric admissions in northern Arizona. That facility is PAC — operated by The Guidance Center. The Guidance Center holds the only northern Arizona contract for Title 36 admissions.
The therapist who initiated my hold was employed by The Guidance Center. The facility that received me was operated by The Guidance Center. The Guidance Center is paid for every Title 36 admission they receive; and my former therapist never conducted an ethical assessment.
I want you to hold that structure in your mind as you read what happened next.
May 8th in the evening
I arrived at PAC with Cinnamon. She is my psychiatric service dog — trained to alert on panic attacks and perform deep pressure therapy, both ADA-recognized tasks. She is Public Access trained. She was working from the moment we arrived.
My vitals were elevated when I came in. They stayed elevated the entire time I was there. Fear does that and I was terrified; the title-36 was ethically questionable from the beginning and I knew that. Being involuntarily committed based on five words — I feel suicidal — with no assessment, no context, no conversation about what those words actually meant — does that to a person’s body.
I was frightened. I was shut down. I was not a threat to anyone.
Kylie Hansard
The next morning, the charge nurse approached me.
Her name is Kylie Hansard, also known as Kaia Marie Manas. She is currently under investigation by her licensing board for her conduct during my admission at PAC.
She announced that Cinnamon was being removed to a shelter.
Not proposed. Not discussed. Announced.
I argued. I asserted my rights. I told her what the ADA requires — that a hospital may not immediately remove a service animal, that the law specifies a step-by-step protocol before removal is even on the table, that the protocol begins with reasonable accommodation and ends with assisted efforts to find outside help, and that medication is explicitly not a legal justification for removing a service animal.
She shut me down; and I was powerless and terrified.
I begged her to contact her legal department. To look up the laws herself. I told her they were not difficult to find. I told her that with a couple of hours and my phone I could almost certainly find someone who could come in and take Cinnamon out for potty breaks — which is precisely what the ADA requires the hospital to permit. I told her that if that failed, the ADA requires the hospital to assist me in finding that person.
She left. She came back. She told me she had consulted legal.
And then she told me why Cinnamon was being removed.
They could medicate my need for her.
I need you to understand what she said. Not as a personal statement — as a legal position. The ADA is unambiguous: a service animal may not be removed because the hospital can treat the handler’s condition medically. Medication is not a substitute for a service animal under federal law. The protocol still applies. All reasonable efforts must still be made.
Did Kylie Hansard / Kaia Marie Manas consult someone? — legal counsel or otherwise — and came back with a justification that has no basis in the law she claimed to have just reviewed.
That was the last conversation before seven people entered my room.
Seven People
I was on the floor. I was in a hospital gown. I was holding Cinnamon.
Seven people entered my room. Among them were animal control officers. Animal control officers entering a psychiatric patient’s room is a HIPAA violation — my status, my location, my admission were not information they should have had access to. I fully believe this was done to humiliate me.
They had already removed Cinnamon’s leash.
I asked for a towel. If I could not have her leash, I could use a towel to guide her. To make this less frightening for her. To give my hands something other than her to hold onto.
No.
I was not threatening. They had spent enough time engaging with Cinnamon — against my explicit, repeated instructions — to know exactly how we both behaved. I was sitting on the floor in a hospital gown saying: No. This is wrong. You cannot do this.
They piled on top of me and took her.
What That Restraint Did
Being held down while saying no is not a neutral event for me.
It has a history. It connects — in the body, not in the mind — to other times I said no and was ignored. Including in circumstances that have nothing to do with a psychiatric unit and everything to do with why trauma lives in the body long after the event that caused it.
PAC did not know that history. They did not ask. A trauma-informed assessment before physically restraining a involuntary psychiatric patient would have asked. PAC did not conduct one.
The flashbacks that followed were not only about Cinnamon, or about that room, or about that night. They were about the weight. The floor. The gown. The specific combination of being held down while saying no and being ignored — and every other time in my life that combination had been true.
That is what Kylie Hansard authorized when she sent seven people into my room.
The Night
After the restraint, after Cinnamon was gone, I did not sleep.
I was terrified. Not abstractly — physically. My heart was pounding. I could feel it. My vitals, already elevated all day, were now reflecting what my body was living through: a Title 36 hold, a service dog forcibly removed, a physical restraint that connected to the deepest trauma of my life, and nowhere to go.
I stayed awake out of pure terror. At some point overnight I began to feel chest pain radiating into my jaw. My heart rate was between 135 and 150. My blood pressure was between 190-220 over 90-110.
I asked for medical attention. I asked because I was frightened of my own body. I could feel my heart pounding
The night nurse refused.
I was given clonidine. There is no documented reason in my chart for why.
The Threat
Another nurse approached me with a blood pressure cuff.
She told me that if I did not cooperate, they would hold me longer — and I would lose my dog.
This was delivered to a person whose cardiac vitals were in crisis range. A person who had just been physically restrained. A person who had been awake all night in terror. A person who had already lost her service dog.
This is what The Guidance Center and PAC calls psychiatric care.
Dr. Sarah Altenberg
The next morning, the psychiatrist arrived for her shift.
Her name is Dr. Sarah Altenberg.
She interviewed me. She looked at what was happening — at my vitals, at my chart, at me. She saw that I was being harmed. Her documentation was accurate. It noted my elevated vitals. It reflected what she actually observed.
She released me from the hold.
A few months later, Dr. Altenberg left PAC to open her own private practice. I later attempted to contact her. She did not respond.
I record those facts without speculation.
What I know is this: in a building full of people who made choices that night that harmed me, Dr. Sarah Altenberg made a different one. She is the only person in this story who did. In an institution where The Guidance Center and NARBHA hold significant local power — over careers, over contracts, over livelihoods — she looked at what was happening and called it what it was.
That takes something. I have not forgotten it.
The Ambulance
I was transferred by ambulance to Flagstaff Medical Center for a cardiac workup.
That transfer does not appear in my PAC chart; neither did the reason why I needed an ambulance get charted.
The ambulance that took me away because my cardiac vitals were critical — the transfer that happened because what they did to me put my body into genuine medical crisis — is absent from the official record of my stay.
My chart contains multiple inaccuracies, entered by multiple staff members. This was not one person having a bad night. This was a pattern: multiple people, multiple entries, a consistent narrative that does not match what happened in that room. A narrative that, taken together, works systematically to discredit a patient who knew her rights and said so out loud.
FMC
At Flagstaff Medical Center, a nurse sat with me.
He used coregulation. He stayed present. He helped my nervous system find its way back from what PAC had sent it into.
His name was John, and his kindness that day is not forgotten.
In one interaction he did what the entire PAC admission had failed to do: he treated me like a person whose nervous system was trying to protect her, not a problem to be managed, discredited, and removed.
That is where the PAC story ends.
Not because it was resolved. Not because anyone was held accountable that night. But because a stranger in a different building did her job with humanity, and my body finally believed it was allowed to come down.
What This Was
I was placed on a Title 36 hold by a TGC therapist with no formal assessment. I was sent to a TGC facility — the only facility in northern Arizona that holds the Title 36 contract. I was held there while my service dog was removed in violation of federal law, while my cardiac vitals went into crisis range and medical attention was refused, while a nurse threatened me with extended detention, and while multiple staff members entered inaccurate information into my chart.
The psychiatrist who saw through it left a few months later.
The charge nurse who authorized the Cinnamon removal is under licensing board investigation.
The therapist who initiated the hold with no assessment received a letter of concern from her licensing board and retired.
The complaint I later filed about all of this was dismissed on statute of limitations grounds — after a three-month delay that ran out my remaining filing windows with the Arizona Attorney General and the Office for Civil Rights.
Nurse Hansard AKA Nurse Manas tried to intimidate me into silence.
That is the next article.
