It was a suicide no one saw coming. By every account south Texas lawyer Hermes Villarreal was a man at the top of his game. He had a beautiful, loving wife, three happy school-aged children, a successful personal-injury practice and an impressive track record of meaningful community involvement.

It wasn't enough, however, to protect him against a crush of acute depression. On April 16, 2005, Villarreal, a solo practitioner in Pharr, was admitted to a McAllen hospital. On April 19, 2005 -- the morning he was to be discharged -- he took his own life. He was 41 years old.

His family blamed the hospital for his death, and on March 5, 2008, a jury in the 389th District Court in Hidalgo County agreed, handing down a unanimous plaintiffs verdict for $9 million in the negligence suit Villarreal, et al. v. Rio Grande Regional Hospital Inc., Columbia Rio Grande Healthcare L.P., d/b/a Rio Grande Regional Hospital.

"It was one of those trial moments in a career that you never forget," says plaintiffs lawyer Raymond L. Thomas, who helped try the case. But for Thomas, it wasn't just about the win. Villarreal had been his best friend.

"Hermes cared about other people. He didn't want to let anyone down. He didn't want to let his community down, his family down or his mother down, and when he wasn't able to keep it all going, it fed anxiety and depression," says Thomas, a partner in Kittleman, Thomas & Gonzales in McAllen. "He had the symptoms, and he didn't know what was wrong with him."

It started with tension headaches, says Clem Lyons of Rhodes & Vela in San Antonio, who also represented the Villarreal family. "For four or five years, he had tremendous headaches. ... Every time he'd go in [to a doctor's office] for a work-up, they said it was stress-related," Lyons says.

Villarreal's headaches, along with feelings of anxiety, remained vague until shortly before his suicide, says Mary Wilson, also a partner in Rhodes & Vela, who worked on the case.

"Just leading up to this hospitalization, he'd go through periods of insomnia where he was awake for days, and at work he had difficulty concentrating. He wasn't picking up on what people were saying, he couldn't focus on his cases and he had a sensation of his heart racing and thought maybe he was having some sort of a heart event. He told the ER doctor and the internist that he felt like he was under tremendous pressure in his legal practice. He thought he wasn't pulling it off and had felt like that for several days" before he went to the hospital, Wilson says. "He was an alpha male, an A-type personality and totally driven -- independent in every way and providing for everyone very well -- who had an acute psychiatric condition, and he needed care."

On the morning of April 16, 2005, "his wife found him writing on a legal pad that he thought he was going crazy," Lyons says. Villarreal initially wanted to go to a hospital in San Antonio for help but agreed when his wife suggested he stay closer to home, Lyons says.

Villarreal was admitted to Rio Grande Regional Hospital in McAllen, and because he said his heart was racing, he was put in the telemetry ward, where his heart could be monitored 24 hours a day via an EKG machine, Wilson says.

The defendants maintained that when Villarreal came to the hospital, doctors were not told about the note he had written that morning. As alleged in the defendants' third supplemental original answer, Villarreal also refused a psychiatric consultation and did not take certain medications ordered by his doctors.

On April 18, 2005, Wilson says doctors came to Villarreal's room to tell him that, based on the results of medical tests he had undergone, there was nothing physically wrong with him and the hospital could discharge him the following day.

At 5 a.m. on April 19, 2005, Villarreal summoned the nurse on duty and requested a razor, saying that he wanted to take a shower and shave his chest, because the EKG monitor leads attached to his chest were bothering him, Wilson says. The nurse complied, giving him a double-edged razor and leaving him unattended, ostensibly to shave himself, Wilson says.

Villarreal took the razor with him into the bathroom, where he locked the door, stepped into the tub, cut himself and then bled to death, Wilson says.

There was a nursing shift change around 7 a.m., says Wilson, where the night nurse informed the day nurse that Villarreal was in the shower; the oncoming day nurse looked in the room and saw the bathroom door closed. The nurse checked in on Villarreal again around 8:15 a.m. and noticed that he was not in the bed and his breakfast tray had not been touched, so she checked the bathroom door and discovered it was locked, Wilson says. When hospital maintenance workers opened the door at 8:25 a.m., she says, it was too late.

Villarreal's estate, wife, children and mother sued the hospital, alleging, in part, that its nurses were negligent by giving Villarreal the razor and failing to adequately monitor and check on him, according to the plaintiffs' fourth amended petition.

The defendants denied the plaintiffs' allegations, asserting, among other things, that Villarreal's death was a "tragic but unforeseeable event," according to their answer. The defendants also claimed that Villarreal's history of headaches was an "underlying and unforeseeable medical condition which caused or contributed to his intentional acts of committing suicide," and this "pre-existing medical condition" made his "chance of avoiding the ultimate harm improbable."

Representing the defendant hospital at the trial, which spanned three weeks, were Bill Gault, a partner in the Brownsville, Texas, firm of Vidaurri, Lyde, Gault & Quintana; A. Scott Johnson, a partner in Johnson, Hanan & Vosler in Oklahoma City; and Terry Todd, a partner in Tulsa, Okla.-based Rodolf & Todd. Gault declines to comment, because the case is ongoing, and Johnson did not return two telephone calls seeking comment.

Although the jury returned its verdict on March 5, the final damage award is unknown, because Judge Leticia Lopez has not yet entered her judgment based on post-verdict motions, says Wilson.

As to whether there will be an appeal, it depends on what the judgment is, says Todd, who is not involved in the post-verdict motions. That amount will be determined following motions filed by Wilson's firm, which she says will be finalized and filed once the firm receives the trial transcript. But both sides agree that the plaintiffs will walk away with far less than the $9 million verdict thanks to mandatory statutory damage caps.

Gault and Todd decline to speculate on the amount the court will ultimately award, but Wilson says the most the Villarreals can recover by law is $1.64 million, and she will argue that $1.64 million is the amount they should receive.

THE EPIDEMIC OF DEPRESSION

A few months after Villarreal's suicide, Thomas says a DVD from the State Bar of Texas landed on his desk called "Practicing From the Shadows: Depression and the Legal Profession."

He doesn't remember exactly how it happened to appear on his desk, but he watched it. The 31-minute video includes commentary from psychiatric and social-work experts explaining depression -- its symptoms and how it can successfully be treated -- along with interviews with four Texas lawyers who suffered from depression while practicing and were able to recover and continue their practices.

Thomas says it was like watching the story of Hermes Villarreal play out on a small screen. "I felt like I was looking in the mirror. Obviously, being his best friend, I thought, 'Where the hell was I?' " he says. "But at the same time, there was a lot of self-reflection. 'Am I on the same track? How many of my peers are on the same track?'"

One point Thomas says the video brought up was how the personality traits that make people good lawyers -- perfectionism, for example -- can also make them more prone to depression. "We tend to be perfectionists, and we tend to be extreme worriers. You can't stop working. You think, 'Something will happen if I don't keep going,' and if you combine that, you are set up" for depression, he says. "I think as lawyers, we consider ourselves superhuman, and we create this image for ourselves. Even though no one else expects us to live up to this image, we do."

But the video did more than just teach Thomas about depression and the pervasiveness of the disease within the legal profession. He says it also inspired him to help spread the word. "I don't think as a profession we do enough to educate our own lawyers or to help -- to be aware of the symptoms and to recognize the symptoms in our peers," he says. "Unless we continually talk about things we are not comfortable talking about, we could be the next victim."

Studies have shown that lawyers are at a significantly higher risk for developing the illness of depression than other professionals, according to a report by the State Bar of Texas' Special Task Force on Lawyer Mental Health Issues. The task force presented the report, called "Lawyer Mental Health: Acknowledging the Challenges, Raising Awareness and Providing Solutions," (.pdf) to the Bar's board of directors on April 27, 2007.

Among the other findings included in the report:

• "Those who suffer from perfectionism are at higher risk for suicide."

• "[L]awyers are notoriously reluctant to seek help for personal issues."

• "Research conducted at Campbell University in North Carolina indicated that 11 percent of the lawyers in that state thought of taking their own life at least once a month."

• "Male lawyers in the United States are two times more likely to commit suicide than men in the general population, according to a 1992 study by the National Institute for Occupational Safety and Health."

• "Most mental health concerns such as depression and anxiety are highly treatable."

Former State Bar president Martha Dickie commissioned the video and appointed the task force as part of her focus on lawyer mental health issues during her 2006-2007 presidency. "Lawyers and suicide -- it's rampant," says Dickie, a partner in the Austin, Texas, firm of Akin & Almanza. Since the video was completed in January 2007, Dickie estimates the Bar has given out more than 1,500 copies, and she's still handing them out and sending them out, always by request. "The more we can talk about it, and the more people who can see this video, the more people we can save. I am absolutely convinced that this video is saving lives," she says.

Dickie decided to make mental health a priority when, at the start of her campaign for State Bar president, her friend and colleague, Kenneth Malcolm "Mack" Kidd, committed suicide on Jan. 3, 2005. Kidd was a justice on the 3rd Court of Appeals in Austin, and his suicide shocked the Texas legal community.

"There is a stigma attached to it," Dickie says of depression. "It's even harder for people who are successful. 'Look at everything he's done. He's too fabulous! He's too strong! Look what he came from and what he did!' But depression is fairly egalitarian, and sometimes the mighty, because they are such pillars, are less likely to get help."

That certainly seems to be true in Villarreal's case. Thomas says he didn't see it, nor did Terry Crocker, CEO of Tropical Texas Center for Mental Health & Mental Retardation, a community mental health facility where Villarreal served as a volunteer chairman of the board from 2001 to 2005. Crocker credits Villarreal with being "a big driver" behind the hospital's ability to expand into two new buildings: one in Edinburg, the other in Brownsville. Crocker says Villarreal's contribution to the expansion assisted significantly in the center's ability to service more than 14,000 patients across Cameron, Hidalgo and Willis counties, which Crocker describes as among the most poverty-stricken yet fastest growing counties in Texas.

"Hermes was very much a champion for the people," Crocker says. "It was a source of frustration to not be able to do something for someone who has meant so much to our agency, but it shows that this can happen to anyone -- depression and mental illness, in general -- and there is no one who is immune from being affected."

A commemorative portrait of Villarreal now hangs in the center's boardroom.

Villarreal's suicide also surprised Dahlia A. Perez, his legal assistant and lone office employee for 12 years. "I didn't see it coming. I had no indication. There was nothing different in the couple weeks prior to his death that I could see," says Perez, who now works for Kittleman, Thomas & Gonzales. Perez also helps manage rental properties that the Villarreal family owns.

"I was at the office signing up a new case when I got the phone call that he hadn't made it. That was all I was told, and I didn't understand, because I had spoken with him several times from the hospital about some cases."

Under Thomas' direction, for a year following Villarreal's death, Perez continued to work from the office -- located behind two retail stores in a strip mall Villarreal owned -- to resolve the firm's outstanding cases. Then she moved to Thomas' office building in McAllen.

But she says, aside from the files, Villarreal's office is mostly as it was three years ago. "The office is still intact. We can't come to terms with moving the stuff out," she says. "His office is under lock and key, but when I go [to the building] to collect the rents, sometimes I go in and sit down. I find peace there."

The office space is, technically, for rent, but when people call to ask about it, Perez says she tells them, "'There's other office space available in that strip.' So I just show them that."

MANAGING EMOTIONS AT TRIAL

After Villarreal's death, Thomas stepped in and took over his friend's remaining caseload, which, he says, consisted mainly of personal injury suits and criminal defense matters. "Remember, he was a perfectionist -- everything was in perfect order," Thomas says.

Thomas also started representing Villarreal's estate in the probate proceedings but, at that time, had no formal involvement in the family's suit against the hospital, which was being handled by Rhodes & Vela. As the case got closer to trial, however, that changed.

"As it became more and more apparent that the hospital was not going to settle, we sort of commissioned [Thomas'] assistance," Wilson says, especially when it came to helping prepare Villarreal's widow and mother to testify at trial. Wilson also says that Villarreal's mother is a Spanish-speaker, as is Thomas. Working with Thomas, Wilson says, "totally made them better witnesses -- just the level at which they knew each other, it was from the heart."

Thomas says at first he was reluctant to step in. "I was worried about being able to handle that emotionally," he says. "I had mixed emotions. It's what I do, I try cases, and I enjoy it -- but I just always thought I'd be a witness, and I had not prepared myself, mentally, to be a lawyer in the case, especially since the case was in the hands of excellent lawyers." Adds Thomas, "It was the most difficult case I have ever tried."

He says he didn't come out and tell the jury of his connection to the plaintiffs, but he says the jury "figured it out," especially following his emotionally charged direct examination of co-plaintiff Hermelinda Villarreal, Hermes Villarreal's mother.

During direct, he showed Hermelinda the watch he was wearing that day, a Cellini Rolex that her son had given Thomas. "I showed his mother the watch and said, 'Do you remember this watch?' She started crying and said, 'Yes, I do.' And I said, 'Tell the jury how I ended up with this watch.' And she said, 'Many years ago, you closed a case for Hermes. He was worried about you and worried that you were working too hard. He wanted to get you a beautiful watch,' " Thomas recalls Hermelinda saying.

Hermes Villarreal had the watch inscribed with the date he and Thomas closed the case together -- Dec. 6, 1996 -- and with it, gave Thomas a note that read, "Ray, You need to take care of yourself and slow down. The reason for the watch is this: Every time you look at your watch, remember how precious time really is, and remember to spend it wisely with your family and loved ones."

"Isn't that ironic?" notes Thomas, a husband and father of two. "He was worried about me being overextended and working too hard."

At trial, Thomas also gave a portion of the closing arguments, says Wilson, and once again his connection to Villarreal made a difference. "It was absolutely compelling. He was able to say, 'I knew this man.' It was very brief but very powerful."

Wilson says Thomas included the story of the watch in that closing argument. "There wasn't a dry eye in the courtroom," she recalls.

This year on Sunday, April 20 at St. Anne's Catholic Church in Pharr -- the day following the third anniversary of Villarreal's death -- Villarreal's church dedicated its mass to his memory, says Thomas. "The priest announced the intention of the mass and asked that everyone pray for the soul of Hermes," he says. Thomas says he and his family are still sad, but he is hopeful that, if there can be a silver lining to the tragedy, it will come through spreading the word in the legal community about depression and how it can be successfully treated.

"If it causes one lawyer to look in the mirror and say, 'That's happening to me,' or, 'That's happening to one of my colleagues,' it will all have been worth it," says Thomas. "It's too bad it takes a tragedy like this for people to become self-aware, but perhaps this tragedy will prevent some others."

To obtain a free copy of the State Bar of Texas DVD "Practicing From the Shadows: Depression and the Legal Profession" or to discuss concerns about depression, call the Texas Lawyers' Assistance Program at (800) 343-8527.

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