Failing Sarah: How a 12-year-old girl ended her own life as her family fought for months to save it

Editor’s note: This story includes discussion and descriptions of a child’s suicide. If you or someone you know needs help, call or text 988, the National Suicide and Crisis Lifeline in the United States.

Sarah Niyimbona was “love, light, talent and potential,” her family remembered in an interview last week. But after months of anguish and loneliness, the 12-year-old girl took her own life on the warm spring evening of April 13 by jumping from the fourth floor of a parking garage at the hospital where she was being treated for mental health challenges.

Her death has left her family grief-stricken and angry, and her caregivers at Providence Sacred Heart Children’s Hospital devastated. It also has raised major questions about how a girl with so many warning signs could have left her room.

Her mother, Nasra Gertrude, wants to know how Sarah was able to slip out of her monitored hospital room, ride an elevator, walk to the parking garage and jump from the structure near Seventh Avenue and Bernard Street.

She recalled being told to hurry to Sacred Heart. When she arrived, she burst into Sarah’s room to hold her child for the last time.

“I ask what happened,” Gertrude told The Spokesman-Review. “How come she left the room without anybody seeing her? How come she walk all the way to the elevator without anybody seeing her?”

Answers to those questions are at the heart of an ongoing investigation by the Washington state Department of Health and an internal inquiry by Sacred Heart.

But such details won’t be publicly disclosed until the investigation concludes, according to DOH. And Providence Sacred Heart leadership has declined interview requests, citing patient privacy laws and a pending lawsuit.

News of Sarah’s suicide was first reported by InvestigateWest.

Gertrude blames the hospital for Sarah’s death. She had been under its care since January.

“I feel like they neglect my daughter and they neglect me. I feel like they were tired seeing Sarah there, so they didn’t care about looking after her all the time,” she said.

In a brief statement, Providence wrote: “We are heartbroken about the tragedy that occurred at Sacred Heart Medical Center. Safe, compassionate care is always our top priority. We believe that Sacred Heart Medical Center provides compassionate and thoughtful care to our patients in alignment with our mission and values. We extend our deepest sympathy to the patient’s loved ones.”

Attorney Matt Conner, who represents Gertrude, said the family looks forward to seeing the results of the investigation. The DOH issued what’s called an immediate jeopardy notice to Sacred Heart the week of April 28.

Immediate jeopardy occurs when a medical provider’s noncompliance has “placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death,” according to the Centers for Medicare & Medicaid Services.

Hospitals have 23 days to fix conditions that caused CMS to issue an immediate jeopardy notice. In the case of Sacred Heart, investigators said the hospital quickly implemented a safety plan addressing the issues raised.

If hospitals fail to fix the problems, CMS can suspend that hospital’s participation status. In the case of Sacred Heart, suspending or ending participation in Medicaid and Medicare would erase 77% of its revenue and cripple the largest health care provider in Eastern Washington.

“This was a needless tragedy. We will be initiating litigation shortly,” Conner said Wednesday.

Sarah’s secret pain

Gertrude is a single mother of six children between the ages of 3 and 19. A native of the Congo, she escaped her home country in the 1990s as a refugee during the genocide in neighboring Rwanda. She lived in Tanzania until immigrating to Spokane in 2010. She came with no other family except young children.

Sarah was born to Gertrude in the United States in 2012. Her father had not been present in her life and now lives in Kentucky, according to Gertrude.

The family lived in a Spokane apartment until displaced by a fire. They eventually moved in 2023 to Cheney where the cost of living is lower.

Before the move, Gertrude described Sarah as a happy child.

“Sarah loved everybody. She was a friend. She was welcoming. When she sees you, she wants to know where you come from. She wants to know you. Wanted,” she said.

But at Cheney Middle School, Sarah complained of being bullied. Children would call her ugly and big. A giraffe. She would fight these students and was suspended several times, according to Gertrude.

In a statement, Cheney Public Schools officials said they were “deeply saddened” by Sarah’s death.

“As we mourn this loss, we continue to focus on supporting our students, staff, and families throughout our school community,” district spokesperson Jenna Larson said in a statement.

Starting last fall, Sarah would often wrap a scarf around her arm. She told her mom it was a fashion statement.

One day, Gertrude forced Sarah to remove the scarf, revealing numerous scars from where Sarah had been cutting herself.

Gertrude didn’t understand at first. Where she grew up in Africa, she said, the concepts of mental health and being suicidal are not discussed.

“Mental health in my country… Maybe it’s there, maybe it is not. I never hear or see a child at Sarah’s age going through depression. I never hear or see anybody who killed themselves,” she said. “So when I see the cutting, I ask ‘What is that?’ And they would try, they would try to explain. It was hard for me to click in my mind that this is something very, very serious.”

Gertrude’s 19-year-old daughter, Asha Joseph, said she was shocked by Sarah’s self-harm. Sitting with her mother, she remembered thinking of her sister as a “sweet, optimistic person” who “found the light out of everything.”

But she knew her sister needed help and persuaded Gertrude to call 911. It marked the beginning of the family’s engagement with mental health treatment for children. Within six hours, Gertrude said, Sarah was released from the hospital.

Sarah’s self-harm behavior quickly escalated to attempting suicide.

According to Gertrude, Sarah was encouraged in this behavior by a 14-year-old girl who lived in the same Cheney apartment complex. After the two attempted to carry out a suicide pact, Sarah was taken back to Sacred Heart and within a few days was admitted to Inland Northwest Behavioral Health, a facility with a 25-bed inpatient psychiatric unit designed for children between the ages of 12 and 17. After a stay of a week or two at INBH, Sarah returned home.

It didn’t take long for Sarah to try again. From October to mid-January, Sarah made “countless” suicide attempts, Gertrude said.

“It was just back and forth. She would come home. Maybe stay a week or two. And then she would attempt and go back to the hospital and might be transferred to INBH for a week or two. Then she comes home and it happens again,” she said.

Between October 2024 and her April 13 death, Sarah was admitted to Sacred Heart nine times and transferred to Inland Northwest Behavioral Health four times, Gertrude estimated.

As her access to ways to hurt herself were restricted, Sarah found other means. At one point, she broke a colored pencil and used the wooden shards to cut away at her arms. She swallowed her mother’s sleeping medication. She stole cough medicine from a gas station. When admitted for care, Sarah shared with her mother that she tried to jump out of windows and often fantasized about jumping out of the large window in her Sacred Heart hospital room.

All the while Sarah rotated in and out of the hospital and INBH, Gertrude had to continue working as a full-time home care aid for the elderly to support and care for Sarah and her other children.

“I was very scared and tired. I didn’t know what to do,” she said.

In January, Sarah was released from another hold at Sacred Heart into Evangeline’s House, a foster care and group home in Spokane run by the Salvation Army. Within two weeks, she attempted suicide by jumping out of a second story window. After that, Gertrude said, Sarah was readmitted to Sacred Heart.

Gertrude said she stopped working by March and applied for paid family and medical leave to better take care of her children and visit Sarah more often. During this time, Gertrude said Sarah’s reasons for harming herself often changed.

“She would tell me that she does not know why she’s feeling this way. Sometimes she would tell me it is because of friends’ bad influence. Sometimes she will tell me that she wants me home. That I work a lot. Sometimes she’ll say, ‘I want my dad in my life. I want to see my dad when my dad is not in my life,’ ” Gertrude said.

Sarah also told her she worried about inflicting financial hardship on the family.

Gertrude said Sarah once found several hospital invoices that detailed the cost of treatment. The family’s sudden onslaught of medical bills was a source of great anxiety for the 12-year-old, and Gertrude made it a point to try and hide the medical notifications and assure her that hospital stays and treatment elsewhere would be taken care of by the government.

“I would tell her, let me worry about it. I know you need help, and those bills is not your problem at all,” she told Sarah.

Clamoring for care

Sarah’s extended stay at Sacred Heart is the outcome of a mental health system that is failing to match the needs of a growing number of children. Often a safety net for those with nowhere else to turn, hospitals such as Sacred Heart are not set up to care for children needing psychiatric care for weeks or months.

“Hospitals are acute settings. The goal in an acute setting is stabilization so that you can step to that next place. Residential inpatient treatment is set up to feel a little more homey. A place where you can be a long time,” said Washington State Hospital Association Director of Behavioral Health Brittany Weiner.

Sacred Heart did have its own 24-bed inpatient child psychiatric unit until last year, claiming that a shortage of child psychiatrists, high costs and a low number of patients made the medical offering unnecessary. The hospital instead agreed to send people who qualify for such care to INBH if they are outside the scope of enhanced outpatient services.

During the final months of Sarah’s stay at Sacred Heart, INBH had such bed capacity. But Sarah, it was determined, needed something different.

So her care team and mother tried to find Sarah an appropriate facility better able to help her.

Such facilities have what are called Children’s Long-Term Inpatient Programs, or “CLIP beds,” considered the most intensive inpatient psychiatric treatment available. The average stay at one of these facilities is nine months, but the goal is to return the child to their home as soon as possible. CLIP is a publicly funded Washington state program that is supported by Medicaid, the federal and state government insurance program.

“CLIP is a course of psychiatric treatment with a focus on stabilization and skill development/acquisition that aims to reintegrate children and youth back to their homes, families, communities, or long-term supportive environments, as soon as deemed clinically appropriate,” the website reads.

These facilities are available to children between the ages of 5 and 17. Children ages 13 and older can be involuntarily held at a CLIP facility for up to 180 days via a court order. But any child 12 and younger must be voluntarily admitted to the treatment program, which has four facilities in Washington totaling 109 beds. There’s one in Eastern Washington, but Spokane’s Tamarack Center is a small facility with only 16 beds available at any one time.

With how limited CLIP beds are, children in need of them often languish for weeks or months awaiting availability.

During her three-month stay at Sacred Heart, the hospital’s care team found Sarah an open CLIP bed in one of the facilities in the Seattle area. Though the family was interested, Gertrude said, they passed on the opportunity. Gertrude said she couldn’t arrange for an ambulance and was unable to take Sarah herself because of her responsibility toward her other children.

So Sarah continued to stay at Sacred Heart.

Options run out

Sarah’s death has spurred criticism of the decision to close Sacred Heart’s Psychiatric Center for Children and Adolescents, which provided intensive care that may have been more clinically appropriate for Sarah than a stay in a room in the children’s hospital.

“This tragic suicide, less than eight months after closing the Providence Sacred Heart Psychiatric Unit for Children and Adolescents, raises major questions about access to the specialized care and treatment that adolescents with mental health issues need and deserve,” said David Keepnews, the executive director of the Washington State Nurses Association, which represents the unionized nurses at Providence. “That unit provided much-needed services to Eastern Washington communities. Serious concerns about closing the unit were voiced by nurses and healthcare workers, community members and, notably, by former patients and their families.”

The decision to close the unit was driven by its high cost amid wider financial challenges at the hospital. Sacred Heart had $175.5 million in operating losses in 2023, according to the state Department of Health, though the children’s psychiatric unit was losing about $2 million a year, per the closure announcement last year.

Inland Northwest Behavioral Health is meant to provide capacity for the patients who otherwise would have received care at the Sacred Heart psychiatric center. At the time, INBH spokesperson Jamie Valdez said the organization had the capacity to care for the influx of patients.

Sarah was transferred to INBH at least four times with stays from a few days to more than a week, Gertrude said. During Sarah’s three-month stay at Sacred Heart, there was at least one instance when INBH refused to accept Sarah, her mother claims.

Gertrude did note Sarah appeared to be improving in the weeks leading up to her death.

Sarah’s sister said that she improved the most when she was treated at INBH.

“She really enjoyed INBH. They had a lot of kids there. But where she was in Sacred Heart, she did not get to socialize with a lot of kids. It felt like she’s the only person that would always feel constantly alone. She doesn’t have anyone to really talk to her. So it was hard,” Joseph said.

Valdez had agreed to an interview this week but changed course and instead emailed a written statement.

The spokesperson also noted INBH could not comment on Sarah’s case because of patient privacy laws.

Sarah’s death

For much of her extended stay at Sacred Heart, Sarah had a “designated sitter” who would be in her pediatric hospital room or just outside at all times. About a week before her death, that regimen was changed to someone checking on her every 15 minutes, according to Gertrude.

Whenever Gertrude visited Sarah, an alarm would ring when the door opened.

Sacred Heart spokeswoman Beth Hegde declined to comment on any specifics surrounding Sarah’s case, but when asked generally about locked rooms in the children’s hospital, she said there are none.

Some rooms, she said, are outfitted with door alarms or bed alarms.

Gertrude said she last saw Sarah alive when she visited her on April 10. They spoke again over the phone two days later, on April 12. During the visit and again during the call, Sarah described frustrations with hospital staff for invading her personal space and expressed a desire to come home. Gertrude said she promised to broach the subject at a meeting about her care the following week.

“Mom, I want to come home. I don’t like it here. I’m tired of being here,” Gertrude remembers her daughter saying.

The next day, on April 13 at approximately 5:30 p.m., Sarah left her room, rode the elevators and crossed a skybridge to the parking garage where many expectant parents go for easy access to the maternity ward. Moving across the fourth floor, Sarah overlooked the garage’s entrance on Bernard Street. From that southwestern edge, she jumped onto the concrete four stories below.

Police tape remnants were still tied to a sign at the parking garage entrance this week.

When interviewed for this story more than a week after Sarah’s death, Gertrude said she still did not know which parking garage her daughter jumped from or where she landed. During the interview, she said she perused social media trying to find the location.

“I want to know where she jumped, because that place – it’s gonna stay in my heart forever. I want to be taking flowers there all the time,” Gertrude said.

Two 911 calls were made in the minutes after Sarah’s fall – both from Sacred Heart security workers. Sarah survived the initial impact and can be heard wheezing in the background of one 911 call. The security guards tell Sarah not to try to stand on her broken body as one cradled her and spoke with a 911 dispatcher.

Within minutes, Sarah was taken to Sacred Heart’s emergency room just around the corner.

Her mother paused every few words as she cried and described how she held her daughter telling her to wake up, praying to God to heal her.

In the days after her suicide, a Providence representative called Gertrude with condolences.

Gertrude asked the pressing questions: “How come she left the room without anybody seeing her? How come she walks all the way to the elevator in the open without you seeing her?”

She felt some people grew weary of Sarah after all those months, and that perhaps led to carelessness in her oversight.

“They haven’t given me any answer at all. I trusted this hospital to take care of my daughter,” she said. “My heart got a little peace. At least I can go to work without receiving a 911 call that Sarah had attempted or was taken to the hospital. At least I can sleep. At least I don’t have to worry about Sarah much because I know she’s in safe hands. I trusted this hospital.”