Thursday, December 18, 2014

In 2000, a study was done in which 20 healthy non-depressed volunteers were given the SSRI antidepressant Zoloft (Sertraline). Two weeks into the study two volunteers became dangerously suicidal.

As reported in the Guardian on Sunday 21 May 2000

Much more info at the link

Alarming evidence from a new British study shows that the Prozac class of antidepressants can make healthy men, women and children with no history of depression feel suicidal.

The research undermines the claims of Eli Lilly, makers of Prozac, that people who kill themselves while on the tablets do so because of their depression, and that the disease, not the drug, is to blame for their suicide.

Its findings are particularly worrying because of the increasing numbers of people, including children, who are being given the drugs by their GP for mild depression, and who are not seriously clinically ill.

[...]

It found that two out of 20 healthy volunteers on an antidepressant in the Prozac class called Lustral (or Zoloft in the USA) became dangerously suicidal, compared with none of them when they were put on an antidepressant of a different class called reboxetine.

One 30-year-old woman who took part had a nightmare about having her throat slit after one week and by the end of a fortnight, was suicidal. "She felt hopeless and alone. It seemed that all she could do was to follow a thought that had been planted in her brain from some alien force. She suddenly decided she should go and throw herself in front of a car, that this was the only answer.

"It was as if there was nothing out there apart from the car, which she was going to throw herself under. She didn't think of her partner or child," says the study, published in the journal Primary Care Psychiatry.

Later she completed a diary entry, describing herself as jumpy, anxious and suspicious. "Her mind was racing and spiraling out of control. Then it went blank except for the clear thought that she must kill herself violently by throwing herself beneath a car or a train."

Tuesday, December 16, 2014

Mental health professionals 'may have committed war crimes', report says

As reported in the Guardian

Much more at the link

Health professionals who assisted in the CIA’s torture programme of terror suspects “betrayed the most fundamental duty of the healing professions” and may have committed war crimes, according to a hard-hitting report released on Tuesday.

Physicians for Human Rights (PHR) called for a federal commission to investigate the full extent of health professionals’ participation in CIA torture following last week’s release of the US Senate Select Committee on Intelligence (SSCI) report on the agency’s detention and interrogation programme.

“Under the auspices of the Bush administration, the CIA systematically tortured suspected terrorist detainees, in at least one instance to the point of death. This torture program heavily relied on the participation and active engagement of health professionals to commit, conceal, and attempt to justify these crimes,” PHR concludes.

The report comes days after Dick Cheney, the former US vice president, defended the practices disclosed in the report including “rectal feeding” – arguing the practice was done for medical reasons. Former CIA director Michael Hayden has also claimed that the practice was carried out on medical grounds.

According to PHR, rectal hydration is almost never practiced in medicine because there are more effective methods, and it is never considered as a first option for rehydration or nutritional support. PHR notes that the report indicates that rectal hydration was used to “control and/or punish the detainees ... Insertion of any object into the rectum of an individual without his consent constitutes a form of sexual assault.”

“Rather than reject such brutal practices, medical officers appear to have modified them to increase pain: ‘we used the largest Ewal [sic] tube we had,’ stated one officer in a February 2004 email,” writes PHR.

Dr Vincent Iacopino, PHR’s senior medical advisor and an author of the analysis, said Cheney was “either terribly misinformed or propagating a lie. Any reasonable person knows feeding does not take place rectally.”

The report sets out eight areas where doctors, psychologists and physician assistants may have violated “medical and psychological ethics, domestic and international law, and federal research guidelines”:
  • Designing, directing and profiting from the torture program;
  • Intentionally inflicting harm on detainees;
  • Enabling US department of justice lawyers to create a fiction of “safe, legal and effective” interrogation practices;
  • Engaging in torture research that could potentially violate the Nuremberg Code, brought in after World War II to ban “experiments” like those practiced by the Nazis, and could constitute a crime against humanity;
  • Monitoring torture and calibrating the level of pain;
  • Evaluating and treating detainees for the purposes of torture;
  • Conditioning medical care on cooperation with interrogators;
  • Failing to document physical and/or psychological evidence of torture.
The report is especially damning of the work of psychologists James Mitchell and Bruce Jessen. The SSCI described how the pair – given the pseudonyms “Grayson Swigert” (Mitchell) and “Hammond Dunbar” (Jessen) in the report– designed the so-called “enhanced interrogation techniques” (EITs) used to interrogate suspects.
Much more at the link

Abilify Is Top-Selling U.S. Drug -- But New Reports Question Long-Term Antipsychotic Use

Part of a much longer report seen in the Huffington Post

The author tries to play fair with both sides, but ends up making a muddle of it.

Last month, the news broke that the anti-psychotic Abilify, thanks in part to direct marketing to consumers for depression, has become the best-selling drug in the United States, raking in roughly $7 billion a year. Yet as Jay Michaelson in The Daily Beast pointed out recently, no one's sure how it may achieve its purported effects as an "augmented" treatment for depression.

The alarms about the dangerous and sometimes deadly side-effects of antipsychotics affecting children and the elderly, among others, have been mounting for years. But only very recently have mainstream health officials in the United States and in Britain started to express concerns about these medications, with limited efforts, for example, to rein in their overuse in nursing homes. At the same time, there's a rethinking underway at the National Institute of Mental Health (NIMH), U.K.'s National Health Service and the British Psychological Society (BPS) over the way clinicians diagnose schizophrenia and treat the illness over the long term with antipsychotics. In late November, for instance, the respected BPS released an updated study, "Understanding Psychosis and Schizophrenia," that offers a sweeping challenge to conventional thinking and treatments for schizophrenia.

[...]

The rest of us should be concerned about these trends, too. Nearly one in four visits to a psychiatrist for anxiety will lead to a prescription for an antipsychotic, an "off-label" use not approved by the FDA. What's happened is that the risky anti-psychotics originally intended for schizophrenia, then later approved for bipolar disorder, have seen their use extend to bipolar grade-schoolers and adult depressives with the dubious blessing of a pro-Pharma FDA, often based on shaky science. Now about 85 percent of all antipsychotic prescriptions are for "off-label" uses still unapproved by the easygoing FDA, such as anxiety and insomnia.

[...]

The commonly-hyped notion of an imbalance of chemicals -- especially serotonin -- causing depression, for instance, has largely been discredited in recent research. There is no single biological marker yet found for depression or other mental illnesses, but there are enough indicators showing that biology doubtless plays a key role -- although not yet precisely determined or quantified -- in mental illness. These include studies of identical twins; neural imaging studies highlighting malfunctioning brain activity; and research into abnormal brain development. That research has helped to spur a new federal "brain initiative."

[...]

Now, important recent reports reinforce mounting concerns about the long-term use of antipsychotics and the potential benefits of at least considering using lower dosages. Even the director of NIMH, Dr. Tom Insel, citing recent research about long-term outcomes in JAMA Psychiatry and other journals, has raised questions about these medications

Monday, December 15, 2014

Widow sues Prairie St. John's Mental Hospital for husband's death by suicide

As reported on the InForum Website

A Fargo widow is suing the mental health hospital here where her husband’s body was discovered after he hanged himself hours after being admitted in April, alleging the hospital was negligent in failing to monitor him.

Jennifer Waagen filed the lawsuit Tuesday in Cass County District Court against Prairie St. John’s Psychiatric Hospital.

Scott Waagen used a bed sheet fastened over the top of the bathroom door to try to hang himself. He was found by a psychiatric technician April 26 and died a week later at Sanford Medical Center.

He left behind his wife and three young daughters, all under 8 years old.

Jennifer Waagen’s lawsuit states her husband was admitted to Prairie St. John’s about 13 hours earlier for continuous surveillance after being diagnosed with a brief psychotic disorder.

The lawsuit accuses Prairie St. John’s of being negligent in failing to document and complete accurate assessments of Scott Waagen, and for failing to watch him and prevent his death by hanging.

Lawyers for Prairie St. John’s filed a response to the lawsuit stating no one at the facility was negligent in caring for Waagen, and that his suicide attempt was not reasonably foreseeable.

Instead, as a suicide victim, Waagen’s death was his own fault, the answer states.

Both sides have explored alternative dispute resolution, according to court documents filed with the case.

Jennifer Waagen is asking for at least $50,000 in economic and non-economic damages.
Another case where the shrinks screwed up, and then blame the patient.

Wednesday, December 10, 2014

Meet the Psychologists Who Helped the CIA Torture People

As Seen in New York Magazine

Read Much More at the Link

The Senate Intelligence Committee’s 500-page executive summary of its report on the CIA’s torture program offers some horrifying details about U.S. treatment of detainees captured in the post-9/11 years. It also highlights and adds some details about the important role two psychologists had in both developing the “enhanced interrogation” program and carrying it out.

Within the report, the duo in question are referred to with the pseudonyms "Grayson Swigert" and "Hammond Dunbar." But both the New York Times and NBC News have identified them as Jim Mitchell and Bruce Jessen, two psychologists who have been previously singled out for their roles in developing and legitimizing the torture program.

Both men came from an Air Force background, where they worked on the Survival, Evasion, Resistance, and Escape (SERE) program in which military personnel are trained to resist enemy questioning by enduring oftentimes brutal mock interrogations. Beyond that, though, they seemed otherwise poorly suited for the task of interrogating al-Qaeda detainees. “Neither psychologist had any experience as an interrogator,” the report notes, “nor did either have specialized knowledge of al-Qa'ida, a background in counterterrorism, or any relevant cultural or linguistic expertise.” Despite their lack of experience in these key areas, Mitchell and Jessen “carried out inherently governmental functions, such as acting as liaison between the CIA and foreign intelligence services, assessing the effectiveness of the interrogation program, and participating in the interrogation of detainees in held in foreign government custody.”

So how did these two men come to play such an outsized role in developing and enacting the CIA’s torture program? Much of the story is captured in a 2009 Times article by Scott Shane. Shane writes that Mitchell, who after retirement “had started a training company called Knowledge Works” to supplement his income, realized that the post-9/11 military would provide business opportunities for those with his kind of experience and started networking with his contacts to seek them out.

[...]

“In 2005,” the Senate report states, “the psychologists formed a company specifically for the purpose of conducting their work with the CIA. Shortly thereafter, the CIA outsourced virtually all aspects of the program.” And while the company’s contract was terminated in 2009 amid a growing national outcry over government-sanctioned torture, by then Mitchell and Jessen’s years-long relationship with the CIA had already proven extremely profitable.
The CIA paid two ex-military psychologists $81 million to help design and run torture the program

Of course, the Psychologist who made so much money from the program has been speaking out, defending the torture program.

Is This Guy Crazy?

Tuesday, December 09, 2014

Mount Carmel psychiatrist Andrew Newton pleads guilty to Medicare fraud

As reported on NewsItem.com

A Mount Carmel psychiatrist accused of fraudulently billing Medicare for psychotherapy sessions that didn't happen has pleaded guilty to the charges in federal court Nov. 25.

Dr. Andrew Newton, 42, of Harrisburg, the owner-operator of the Newton Psychiatric Clinic, pleaded guilty to six counts of theft or embezzlement in connection with health care in the Nov. 25 court appearance.

Following the plea, U.S. Magistrate Judge Martin C. Carlson ordered a presentence investigation to be completed by Dec. 23, but Newton's attorneys asked for a continuance, which was granted on Dec. 1. The report must be completed and published on or before Jan. 20, 2015.

Authorities alleged Newton billed Medicare for a face-to-face psychotherapy services with patients in Pennsylvania when Newton was out of the country.

The U.S. Government alleged Newton billed Medicare for three patients Aug. 18, 2010, and for patients Sept. 2 and Sept. 3, 2010, when the doctor was in France, and Nov. 29, 2011, when Newton was in England.

Newton "did knowingly and willfully embezzle, steal and convert to his own use" a total of $322.75 from the fraudulent billing, a past release stated.

A plea agreement reached said Newton will plead guilty to all six of the misdemeanor charges, and the government will not bring any other criminal charges related to the offenses, with the exception of criminal tax charges.

In this case, Newton faces a maximum sentence of six years in prison, a term of supervised release following the imprisonment and a fine.

The plea agreement also states that Newton agrees to make full restitution of $20,000, plus $75,000 payable to the Medicare Trust Fund.

The investigation was conducted by the U.S. Department of Health and Human Services, the Office of the Inspector General and the Federal Bureau of Investigation's Williamsport Office.

Drug Shills Dispensing Pills A psychiatrist questions Big Pharma’s influence on her profession.

A recent article by Jean Kim in the magazine IN THESE TIMES

Jean Kim is a psychiatrist and writer in Washington, D.C., who is finishing her M.A. in nonfiction writing at Johns Hopkins University

In 2009, as an eager young psychiatry professor at New York-Presbyterian Hospital, I presented to faculty on the need for a moral dimension to psychiatric diagnoses. I was laughed out of the room.

One psychiatrist, a schizophrenia specialist, said he didn’t see the point. The acting medical director said he felt I’d called him immoral. A top research psychiatrist said, incredibly, “Morality and psychiatry should be kept separate.”


So a few years later, when ProPublica launched its Dollars for Docs database to track the drug company money doctors were taking, I typed in their names. The acting medical director received $12,550 in 2010 and 2011 for speaking gigs. The researcher received more than $212,489 between 2009 and 2012 for speaking gigs and consultations. The schizophrenia specialist made more than $323,300. And the database only includes disclosures from 17 of the more than 70 drug companies in the world. According to Dollars for Docs, hundreds of thousands of doctors have raked in a total of more than $4 billion since 2009, with the top earner, psychiatrist Dr. Jon Draud, netting at least $1.2 million.

As a psychiatrist who “grew up” in the last decade, I was not surprised.

I started my residency training in New York City in 2000. Lunches and dinners provided by drug company reps were astaple of my diet. For a hungry, harried resident on a paltry salary, a free pit stop at a steaming Chinese buffet was heaven. All around me in Manhattan, investment bankers and freshly minted lawyers were living it up, and I admit that I wanted a piece of the pie as well. By mid-decade, academic psychiatry had become glamorous. A resident might schmooze with a drug rep and get invited to a trendy spot—Nobu, Olives, Tao—where we could imbibe Sex and the City-style cocktails and sample the freshest sushi. Drug reps, selected for their looks and charm, were the popular, beautiful best friends we geeky docs never had.

In 2003, I won a free ride to the American Psychiatric Association annual meeting in San Francisco as part of an Aventis-sponsored fellowship for women in psychiatry. An industry-sponsored gala featured an open bar and a Brobdingnagian spread: tables loaded with huge flower displays, chocolate fountains, petit fours and gourmet hors d’oeuvres. The conference also hosted a Disney-esque exhibit hall full of brightly colored drug company displays with touchscreen computer stations. I filled my free tote bag with gifts—pens, laser pointers, candy, textbooks. My favorite was the Xanax XR clock, whose hands rested on a bed of clear turquoise fluid, to simulate the feeling of floating on a summer pool.

I graduated from residency training and became an attending psychiatrist myself. Back then, it was viewed as a symbol of academic prowess to be on a drug company’s speaker’s bureau. So when an enthusiastic new drug rep from my alma mater invited me, a lowly junior attending, to a speaker training session, I was flattered and accepted. On an all-expenses-paid two-day training trip to Chicago, I stayed at a posh hotel on Michigan Avenue and sat through lectures about the then-new antipsychotic drug Geodon. I was paid $2,500 for going, and another $1,000 for giving a “talk” for about seven minutes a few weeks later at a dinner with a handful of colleagues. Persuaded that I needed to gain experience with Geodon so that I could be a better presenter, I began prescribing it more often. Then I began to see that it was less reliable than other medications. I quit the speaker’s bureau, realizing I had been manipulated into writing more Geodon prescriptions. In fact, the drug rep’s salary depended on such performance increases. Drug companies can track all physicians’ prescriptions—a 2011 Supreme Court decision upheld their right to do so, citing data as “free commercial speech.”

In November 2007, as the economy imploded, a prominent psychiatrist, Dr. Daniel Carlat, wrote a famous essay in the New York Times Magazine about a stint as a pharma shill. He concluded, “The money was affecting my critical judgment. I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.” I read it and realized that I had been going along with the tide—that a colossal, profit-driven advertising engine was using our own psychological tactics to manipulate us.

The next year, heads began to roll. In October 2008, Dr. Charles Nemeroff, then head of psychiatry at Emory University, made the front page of the New York Times for failing to report more than $1.2 million dollars in drug company-related income to Emory, which had strict guidelines for non-academic money. He resigned and now works for the University of Miami.

Dr. Joseph Biederman of Harvard Medical School went one step farther than Nemeroff. As the Times reported in November 2008, he not only hid from Harvard that he’d taken more than $1.4 million from drug companies; he publicly advocated for diagnosing more children with bipolar disorder and prescribing them more antipsychotic medications. The rate of prescriptions for these medications skyrocketed. Antipsychotics should only be used when absolutely necessary, given their potential for serious side effects, especially in children.

Since then, FDA regulations have gotten tighter, and in 2009, the Pharmaceutical Researchers and Manufacturers of America self-imposed a code on interactions with healthcare professions. Drug company speakers can no longer ad-lib invented uses for their medications and have to include mention of “negative studies” if available. Comped dinners must be modest by local standards and include presentations. Pens and trinkets are banned. The once-charming reps can speak to you only if spoken to, not unlike vampires who cannot enter your home unless invited.

The reforms have cut down on blatant pharma influence, but prominent psychiatrists still shill shamelessly, and much research is pharma-funded. Take the October 2014 issue of the American Journal of Psychiatry, the elite scientific publication in our field. Five of the six research articles contain disclosures that one or more of the authors worked or consulted for pharma. It remains to be seen whether more data releases from ProPublica—and now from Open Payments, a federal database mandated by the Affordable Care Act and unveiled in late September—will create enough public backlash to convince these doctors that this type of income does harm. Conflicts of interest weaken the credibility of research and hurt patients by encouraging poor prescribing practices. They also undermine the crucial trust between doctor and patient by fueling the paranoiac skepticism that all psychotropic medications are mind-altering, toxic tools of profit.

The right medications, alongside psychotherapy, can save and improve lives. I have seen people frozen in psychosis or melancholia awaken, as though from a nightmare, after getting the right treatment. I have seen soldiers back from war, riddled with flashbacks, become able to do simple things again, like go to a shopping mall. I have seen people once stuck in hospitals able to work again, to finish school, to have loving relationships. Those moments fulfill me as a doctor and as a human being. But I wish my profession would recognize that our ethics are worth more than a quick buck.


Quote: A top research psychiatrist said, incredibly, “Morality and psychiatry should be kept separate.”

Sums it up nicely, no?

Sunday, December 07, 2014

636,120 Ways to Have Posttraumatic Stress Disorder

Hat tip to "Big Trends in Neuroscience" where I first came across the link. This made the rounds about a year ago while I was on hiatus, but it still deserves extra attention

Diagnosing mental illness: more than half a million reasons to worry


Here’s a fascinating article from Perspective on Psychological Science about the very troubling state of psychiatric diagnosis, using PTSD as the prime example (Galatzer-Levy and Bryant 2013). I know DSM bashing is all the rage (looking at you, Tom Insell), but this paper takes DSM to the woodshed in some new and exhilarating ways. I had my behavioral neuroscience students read it last semester, and it got them appropriately agitated.

Bibliography


Galatzer-Levy, I. R., and R. A. Bryant. 2013. 636,120 Ways to Have Posttraumatic Stress Disorder. Perspectives on Psychological Science. SAGE Publications, November 1. http://dx.doi.org/10.1177/1745691613504115
You can find the full paper in PDF format here

Saturday, December 06, 2014

Psychiatrist Dr. Andrew Newton charged with healthcare fraud

As reported in the Shippensburg News Chronicle on Decenmber 5th, 2014

The United States Attorney for the Middle District of Pennsylvania, announced today that charges have been filed against Andrew Newton, a resident of Harrisburg.

According to United States Attorney, Peter Smith, Dr. Andrew Newton, 42, a psychiatrist with an office in Mount Carmel is charged in a six-count information with false billings for psychotherapy services. Specifically, it is alleged that between August 2010, and November 2011, Newton billed Medicare for face-to-face therapy sessions when he was in fact out of the country.

7 years ago a man was committed to a high-security psychiatric hospital for fabricating a story of large scale money-laundering at a major bank. Internal bank documents have been found that prove his claims.

As Reported in the Daily Morning.

Of course, this abuse of the psychiatric system is brushed off as "not their fault" by everyone who helped get this man committed.

A German man committed to a high-security psychiatric hospital after being accused of fabricating a story of money-laundering activities at a major bank is to have his case reviewed after evidence has emerged proving the validity of his claims.

In a plot worthy of a crime blockbuster, Gustl Mollath, 56, was submitted to the secure unit of a psychiatric hospital seven years ago after court experts diagnosed him with paranoid personality disorder following his claims that staff at the Hypo Vereinsbank (HVB) – including his wife, then an assets consultant at HVB – had been illegally smuggling large sums of money into Switzerland.

Mollath was tried in 2006 after his ex-wife accused him of causing her physical harm. He denied the charges, claiming she was trying to sully his name in the light of the evidence he allegedly had against her. He was admitted to the clinic, where he has remained against his will ever since.

But recent evidence brought to the attention of state prosecutors shows that money-laundering activities were indeed practiced over several years by members of staff at the Munich-based bank, the sixth-largest private financial institute in Germany, as detailed in an internal audit report carried out by the bank in 2003. The report, which has now been posted online, detailed illegal activities including money-laundering and aiding tax evasion. A number of employees, including Mollath’s wife, were subsequently sacked following the bank’s investigation.

The “Mollath affair”, as it has been dubbed by the German media, has taken on such political dimensions that it now threatens to bring down the government of Bavaria. Under the weight of public and political pressure Horst Seehofer, the prime minister of the rich southern state and a member of the Christian Social Union (CSU) – the sister party to Angela Merkel’s Christian Democrats – has now called for the case to be reopened, amid charges that Mollath was possibly the victim of a gross miscarriage of justice.

“The judiciary would be well-advised to reassess the case,” Seehofer said this week. “I want them to concentrate on the question of whether everything has been done correctly.”

His justice minister, Beate Merk, who has refused repeated calls to resign, said she had no doubt the case had been carried out “by the book and quite correctly”.

Mollath has been inundated with public support in the form of thousands of letters and internet posts, many comparing his fight to that of David versus Goliath. He said he was delighted that what he called the “murky business of the bank” is now emerging, 10 years after he first made his claims.

“This is precisely what I wanted to achieve all along,” he told the Süddeutsche Zeitung, which brought the audit report to light earlier this month. In an interview in his sparsely furnished room in Bayreuth’s hospital for psychiatry, he pointed out the irony that he had suffered the fate he had repeatedly warned his wife she would face, telling her: ‘Please be careful. One day you will end up in handcuffs and then you’ll be banged up for a few years'”, he said.

Asked whether it felt any responsibility towards Mollath, a spokeswoman for HVB told: “We don’t recognise any connection between the results of our audit report and either the criminal trial or the commitment of Mr Mollath.”

Asked why the bank kept the report to itself and did not approach the authorities, the spokeswoman added: “In 2003 HVB initiated extensive investigations via internal audits in response to information provided by Mr Mollath on transactions that had taken place a long time before … It was determined that employees had acted contrary to their instructions regarding Swiss banking transactions”.

But while the findings, it said, had resulted in sackings, the audit “did not produce sufficient evidence indicating criminal conduct … that would have made a criminal charge seem appropriate”.

Friday, December 05, 2014

Las Cruces psychiatrist abused former patient, police say

As Reported in the Las Cruces Sun Times

A Las Cruces psychiatrist has been arrested after police say he abused a former patient.

Daniel J. Brandt, 54, was charged with one count of abuse of a resident, a fourth-degree felony, according to a Las Cruces Police Department news release.

Police allege Brandt grabbed the hoodie of a 28-year-old former patient, twisted it in his hand and escorted the intellectually disabled inside Campo Behavioral Health Services on Tuesday. Brand's hold was tight enough, according to police, that the man choked and passed out for a brief time.

Brandt had worked with the man for 13 years, till July when the man's court-appointed guardian requested a change in psychiatrists, the news release states.

The man and caretaker had gone to Campo Behavioral Health Services on Tuesday to reconcile records. That's when Brandt allegedly approached them in the parking lot, suggesting the man see a new therapist at the facility. When the man refused, Brandt allegedly grabbed him.

Reached on Thursday afternoon, Brandt declined to comment on the incident.

He was booked into the Doña Ana County Detention Center on Wednesday on a $10,000 bond. Brand, who has no criminal record according to online New Mexico court records, has since posted bail.

Wednesday, December 03, 2014

The Mysterious Vanishing Brains How could 100 jars of human brains—taken from deceased patients of an Austin mental hospital—just disappear from their home at the University of Texas?

As Reported in The Atlantic

Their article was excerpted from Alex Hannaford's Malformed: Forgotten Brains of the Texas State Mental Hospital.

Somewhere in a little-used room in the bowels of the Animal Resources Center on the University of Texas’s campus in Austin sit around 100 or so large glass jars. They’re stored three-deep on a wooden shelving unit that takes up an entire wall. Glass doors do a fairly good job of keeping off the dust and protecting them from the occasional visitor to this air-conditioned storeroom.

Those jars house an unlikely collection: Each contains a complete—or, in a few cases, a partial—human brain, submerged in formalin. And on most is affixed a label, faded with time but still legible, inscribed with three pieces of information: a reference number, the condition from which the patient suffered (described in archaic Latin), and the date of death.

The specimens, which date back to the 1950s, all belonged to patients at the Austin State Hospital (ASH), formerly the Texas State Lunatic Asylum, an institution that still sits on a shady lot off Guadalupe Street, about three miles north of downtown Austin.

[...]

From the 1950s to the mid-1980s, the resident pathologist at the hospital was a man named Dr. Coleman de Chenar, and it was in the room where he performed autopsies that he began to amass a collection of brains. At the time of his death in 1985, he had around 200 specimens that he’d collected during routine autopsies on mental patients.

[...]

Tim Schallert, a neuroscientist at UT and the collection’s curator, says that when the original brains were bequeathed to the University of Texas, there were around 200 specimens. By the mid-1990s, they were taking up much-needed shelf space at the Animal Resources Center, and Dr. Jerry Fineg, the center’s then-director, asked Schallert if he would move half of the jars elsewhere.

When Schallert got around to it, he says they had vanished. He asked Fineg if he knew what had happened to them, and Schallert says Fineg told him he got rid of them. “I never found out exactly what happened—whether they were just given away, sold or whatever—but they just disappeared.”

[...]

It’s a mystery worthy of a hard-boiled detective novel: 100 brains missing from campus, and apparently no one really knows what happened to them. Going through the official channels at the University of Texas eventually leads to a suggestion that Tim Schallert might know, as he is the collection’s curator. It’s back to square one.

Back in 1986, the Houston Chronicle described a fierce “battle for the brains” between UT and Harvard Medical School, and now 100 of the specimens—half of the original collection—have disappeared. Space at UT was limited, but the director of clinical support services at the State Hospital 25 years earlier had described being “overwhelmed” by calls about the collection. They were, she said at the time, a “valuable research tool.” A Harvard professor had said researchers were “crying out” to get the brain tissue in the UT collection. And yet today, apparently nobody knows where half of this valuable collection has gone. Were they given back to ASH? Were they sold? Were they given away? Will we ever find out?
While the witty suggest zombies, we are not so sure which shrinks would have an appetite for such a collection. It's like something out of a bad movie.

Mental Health Ranks High on Fraud Scale

A recent column by Richard Kusserow

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Kusserow’s Corner: Mental Health Ranks High on Fraud Scale


Occasionally, I take time to bring attention to enforcement actions in various health care sectors. Some recent actions drew my attention back to a special enforcement problem that stretches back decades to my days as Inspector General—mental health. Billions of dollars are spent to address the ever-increasing demand to treat mental stress and illness. The primary purpose of mental health treatment must be the therapeutic care and treatment of individuals who are suffering emotional disturbance. Proper treatment therefore demands the highest level of trustworthiness and integrity in the practitioner, who treats some of the most vulnerable patients. Two sources of funding are Medicaid and state general fund dollars, which on average fund 90 percent of the system. However, about 10 percent is funded by Medicare, federal mental health services block grant funds, and county or municipal funds. As with other areas of health care, a significant portion of these funds are diverted to fraud within the mental health industry. Many health care fraud investigators believe mental health caregivers, such as psychiatrists and psychologists, have the worst fraud record of all medical disciplines. Much of that is attributable to prescriptions for narcotic drugs and taking advantage of some of the vulnerable individuals who suffer from mental illness or Alzheimer’s disease.

Last year the HHS Office of Inspector General (OIG) issued a report focusing on one aspect of the problem: detecting and deferring mental health fraud in community mental health centers (CMHCs). CMHCs provide partial hospitalization program services to approximately 25,000 Medicare beneficiaries. The OIG report cited numerous arrests by Medicare Fraud Strike Forces evidencing significant levels of CMHC fraud. The OIG review found that one of nine MACs reviewed performed activities to detect and deter CMHC fraud, and most of these were part of a CMS-led special project. Activities to detect and deter CMHC fraud varied substantially among ZPICs with many performing minimal activities to detect and deter fraudulent CMHC billing. The report provided a number of recommendations to increase control and enforcement in this arena. However, this is only one area of Medicare that addresses mental health. Other areas are equally prone to fraud and abuse.

The latest in the Medicare enforcement arena comes from Louisiana where the owner of three mental health centers was sentenced to pay $43.5 million in restitution and serve 8-and-one-half years in federal prison for a Medicare fraud scheme. A psychiatrist, who served as medical director and co-owner, was sentenced to 86 months in prison for his role in admitting mentally ill patients to the facilities, some of whom were inappropriate for partial hospitalization, and then re-certifying the patients’ appropriateness for the program in an effort to continue to bill Medicare for services. These were among 17 people who worked at the three facilities in a variety of roles who also been charged in the fraudulent operation that stretched seven years and involved over a quarter-billion dollars in Medicare fraud. They included therapists, marketers, administrators, owners, and the medical director. The companies billed Medicare for unnecessary or never provided partial hospitalization program services for the mentally ill. The companies, collectively, submitted more than one-quarter-billion dollars in claims to Medicare during this period. The scheme also involved falsifying records indicating patients had treatment they never received and paying recruiters to, in turn, pay patients to attend hospitalization programs at the facility in order to make Medicare claims.

The fraud problem is actually larger and more pervasive in the Medicaid program, which provides significantly more funding to this area. For example, last year New Mexico was in the midst of a sweeping criminal investigation into 15 of its largest mental health providers, suspected of defrauding Medicaid of $36 million over three years.

Examples of Fraud in the Mental Health Sector
  • Altering and/or falsifying records to match services billed
  • Billing for services not actually performed
  • Errors and falsification of patient charts
  • Fabricating patient files
  • Paying kickbacks paid to recruiters to find beneficiaries
  • Lack of a referral form from an approved provider source
  • Lack of documentation for service provided
  • Service notes lack specific treatment goal
  • Billing for service not covered by Medicaid as a covered service
  • Billing for a more expensive service than was actually rendered
  • Prescribing category narcotic drugs to addicts or for selling on the street
  • Changing the billed date of service to match client dates of eligibility
  • Deliberately applying for duplicate reimbursement in order to get paid twice
  • Inappropriate billing that results in a loss to the Medicaid program
  • Providing services which are not necessary
  • Billing for services performed by unqualified persons

Mental health scams target Medicare and Medicaid

As seen in this report

Fraud involving Medicare and Medicaid mental health benefits has been "a special enforcement problem that stretches back decades," according to former Department of Health and Human Services Inspector General Richard P. Kusserow. "Many healthcare fraud investigators believe mental health caregivers, such as psychiatrists and psychologists, have the worst fraud record of all medical disciplines," Kusserow wrote. That belief is largely based on numbers of prescriptions for narcotics and exploitation of patients diagnosed with mental illness or Alzheimer's disease.

One fraud hotspot is community mental health centers (CMHCs) that offer partial psychiatric hospitalization programs. In Medicaid, there's been "an explosion of fraud in community-based treatments," including billing for services not rendered, services provided by unlicensed staff or services tainted by kickbacks, according to Assistant U.S. Attorney Ted Radway.

The Medicare Strike Force made arrests for significant CMHC fraud involving programs serving about 25,000 beneficiaries, Kusserow noted. Yet just one out of nine Medicare Audit Contractors reviewed last year by the Office of Inspector General worked to thwart CMHC fraud, Kusserow noted. This finding led the agency to recommend increased controls and enforcement in this area.

A recent case involved Louisiana psychiatrist Zahid Imran who was sent to prison for his role in a Medicare scam involving partial hospitalization services. Imran admitted patients who didn't need partial hospitalization and then recertified their appropriateness for the program to keep the Medicare reimbursement flowing. Imran's crimes were part of a $258 million fraud scheme in which 17 people were convicted, including therapists, marketers, administrators, and owners of facilities in two states. Perpetrators paid recruiters to round up patients and altered documentation to make it look like they received treatment.

Mental health fraud is more pervasive in Medicaid, Kusserow wrote, since Medicaid and the states provide more funding to this area than Medicare. Last year, for example, New Mexico investigated 15 of its largest mental healthcare providers who were suspected of cheating Medicaid out of $36 million in three years.

Tuesday, December 02, 2014

A King County civil jury has ordered Overlake Hospital Medical Center to pay $950,000 in damages to a mentally ill woman who was assaulted while undergoing psychiatric treatment

As Reported in the Seattle Times.

Substantially more details at the link

A King County civil jury has ordered Overlake Hospital Medical Center to pay $950,000 in damages to a mentally ill woman who was assaulted by another patient while undergoing psychiatric treatment at the Bellevue hospital.

Civil attorneys Lincoln Beauregard and Steven Fogg filed the lawsuit last year, alleging that Overlake was negligent because no one was monitoring the video-camera surveillance system in the psychiatric unit where the assault took place. They also alleged that the hospital was not checking in on the mentally ill patients on a regular basis.

“You have a vulnerable 27-year-old woman who was trying to be stabilized. She wasn’t supposed to be sexually assaulted,” Beauregard said Tuesday. “Overlake Hospital repeatedly pointed the finger at her. They said she had opportunities and choices and should have screamed louder.”

The jury reached its verdict Monday after an eight-day civil trial in Superior Court.

Beauregard said his client, who had prior diagnoses of schizophrenia, bi-polar disorder and post-traumatic stress disorder (PTSD), is even more emotionally damaged as a result.

“She now has exacerbated PTSD. She’s severely mentally ill. She’s a fighter who is doing really good trying to get her mental illnesses under control,” Beauregard said.

“This is an unfortunate situation,” Kipepeo “Pep” Brown, the hospital’s director of marketing, communications and community outreach, said in an email Tuesday. “Overlake Medical Center is currently considering our options for appeal. At this point, we cannot comment further on the details of the case or the judgment.”

Emergency Department Visits Attributed to Overmedication That Involved the Insomnia Medication Zolpidem (Ambien)

As seen in this government report from SAMSA.GOV

In Brief:

  • The total estimated number of zolpidem-related emergency department (ED) visits involving overmedication increased for both males and females between 2005-2006 and 2009-2010. 
  • In 2010, females accounted for two thirds (68 percent) of zolpidem-related ED visits involving overmedication; patients aged 45 to 54 represented the largest proportion of zolpidem-related ED visits involving overmedication. 
  • More than half of zolpidem-related ED visits involving overmedication in 2010 included other pharmaceuticals combined with zolpidem (57 percent). 
  • Nearly half (47 percent) of zolpidem-related ED visits involving overmedication resulted in either a hospital admission or transfer in 2010, 26 percent of which were admissions to a critical or intensive care unit.


Read the Full Report at this link

Zolpidem, which is handed out to 750,000 NHS patients in Britain seeking treatment for insomnia each year, has been found to be a factor in dozens of instances of people breaking the law while sleeping.

Another case of the harmful side effects of psychiatric drugs

As reported in the Daily Mail

NOTE: Zolpidem is also known as Ambien by in the the USA

Sleeping pills taken by celebrities including Lindsay Lohan and Tiger Woods – and prescribed widely in Britain – could be to blame for numerous cases of dangerous and even criminal behaviour.

Zolpidem, which is handed out to 750,000 NHS patients seeking treatment for insomnia each year, has been found to be a factor in dozens of instances of people breaking the law while sleeping.

They include 43 instances of driving, nine rapes, eight assaults, ten murders or manslaughters, and burglaries – all of which were claimed to have been carried out while the perpetrator was apparently asleep. In most cases they also had no memory of the event.

Neurologist Professor Mark Mahowald, of Sleep Forensic Associates, a US-based organisation of doctors who help those who break the law while still asleep, says: ‘It appears that one part of the brain responsible for complex activities, like driving or cooking, is awake, while another, involved in memory, is not.

‘In sleep-driving for example, people take the drug, go to bed, and then wake up in the car with their pyjamas on. When the police pull them over, they do not know how they got there.’

Prof Mahowald, of the University of Minnesota Medical School, adds: ‘One of the difficulties in advising people about taking the drug is that it is effective and there does not seem to be any way of identifying people at risk of these uncommon side effects.’

Some 82 medication-related cases worked on since 2006 involved ‘toxicity’ due to Zolpidem. In 79 of the cases the defence was successful.

Troubled actress Lohan has admitted to problems while taking Ambien.

Initially marketed two decades ago as a safer alternative to older, more addictive benzodiazepine drugs, including Valium, in recent years Zolpidem, along with similar so-called Z-drugs such as zopiclone, have been linked to a raised risk of dementia and heart problems.

Numerous studies have reported rare instances of patients driving, eating, making telephone calls and even having sex while under the influence of the medication.

Some experts even recommend that patients secure their bedroom windows and get into bed before taking the drug, to reduce any possibility of harm.

One report, by doctors at the Hospital Italiano de Buenos Aires, claimed that up to one per cent of patients had a sleep-eating problem after taking the sedative. The only clues to their nocturnal feasting were morning leftovers and crumbs in the bed.

Patients being prescribed Zolpidem are already warned that changes in sleep behaviour, including sleepwalking, are a possible side effect, but this is the first time data on criminal behaviour linked to the drug has been comprehensively collected.

New US research shows that the drug is implicated in one in ten emergency department cases due to psychiatric drugs. In over-65s, it accounted for 21 per cent of cases. One theory is that the events actually occur while people are waking from deep sleep.

Although prescribing guidelines state Zolpidem should be used only in the short term, with an initial two-week course recommended, a recent study by herbal sleep aid company Sleepio found that up to 42 per cent of patients on sleeping pills had been taking them for more than a decade, and a quarter for between three and five years. And, according to the Economic and Social Research Council, one in ten of us now regularly takes some form of sleeping tablet.

Dr Guy Leschziner, consultant neurologist at Guy’s and St Thomas’ Hospitals in London, says: ‘These drugs tend to be habit-forming and can have unintended consequences such as these unwanted behaviours.’

[...]

Anchorage psychiatrist changes his plea to guilty in Medicaid fraud case

As Reported on KTUU

video platformvideo managementvideo solutionsvideo player

(I have edited their report for purposes of clean up errors, typos, etc)

Anchorage psychiatrist Dr. Shubu Ghosh has changed his plea in a case of fraudulently billing Medicaid and tampering with evidence. Dr. Shubu Ghosh has plead guilty to billing Medicaid more than $1 million for services he never performed. He said he was guilty for falsifying records in an attempt to cover up the improper billing. Ghosh founded Gosh Psychiatric Services and was arrested in April of this year. His sentencing is set for April of next year, and he could spend one to three and a half years in jail and pay a fine of up to $50 thousand.

Monday, December 01, 2014

Patient at heart of abuse allegations at Kalamazoo Psychiatric Hospital speaks out

As seen in this report from News Channel 3 in Kalamazoo, Michigan

KALAMAZOO, Mich. (NEWSCHANNEL 3) - We are learning more Wednesday night about a criminal investigation into 16 Kalamazoo Psychiatric Hospital employees.

Kalamazoo Public Safety is investigating 19 incidents of possible patient abuse, and all of them involve the same patient.

Wednesday, that patient and his family agreed to tell us their side of the story.

"Pretty much the whole time I was there, I was treated very poorly," said former KPH patient Michael Joseph Rowley, who spent two years at the hospital.

"They would constnatly provoke him into a fight," said his mother, Carla Rowley. "Then they would drag him into a room and beat him up and, you know, that's recorded."

Rowley and his parents told Newschannel 3 over the phone Wednesday afternoon that he has various disorders that make him violent and aggressive, and he also has at least three assault convictions.

We asked him if he ever assaulted employees at KPH.

"Well, to be honest, many times," he said, adding that he was provoked.

"They would tease me, they would bully me," Michael said.

But there was an incident with a resident care aid in June.

"He bent my arm way back and was smacking me around," Michael said. "My arm got broken in two spots."

That sparked the criminal investigation and 28 employee suspensions.

"The actions of the staff are probably prosecutable," said former KPH Interim Director Cynthia Kelly in an October interview with Newschannel 3.

In the course of that interview, Kelly told Newschannel 3 that staff reviewed hundreds of hours of surveillance as a part of their investigation.

"There are a few things that I viewed even just this morning that...restraint was used and it was completely uncalled for," she said.

Current and former employees say forced overtime, exhaustion, and irritation is a major factor.

"You go to work for your 8 hour shift, and you're told you have to stay 16, you have no choice," said an anonymous former employee in mid-September.

Records obtained through the Freedom of Information Act show 236 resident care aids work at KPH.

Through October of this year alone, resident care aids were mandated to work double shifts 4,736 times.

The Department of Community Health hopes to hire a permanent director at KPH before the end of the year.

That person will be charged with reviewing all policies and safety concerns.

As for Michael Rowley, he says he was transferred to another psychiatric hospital on October 10, as the criminal investigation got underway.

DCH expects more information from Kalamazoo Public Safety regarding possible charges by mid-December.

Friday, November 28, 2014

Psychiatric drugs responsible for 90,000 hospital emergency room visits annually

Just can across this recent report in the Formulary Journal from a few month back

Psychiatric drugs responsible for 90,000 ED visits annually

The original study is

Emergency Department Visits by Adults for Psychiatric Medication Adverse Events

Adverse reactions to antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulant drugs are responsible for almost 90,000 emergency department (ED) visits each year by US adults, according to a study in JAMA Psychiatry.

The authors estimated the number of emergency department visits for adverse drug events from the therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants using active, nationally representative surveillance data from the National Electronic Injury Surveillance System – Cooperative Adverse Drug Event Surveillance (NEISS-CADES).

They also estimated the number of outpatient visits at which those drugs were prescribed using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. They used the estimates of ED visits for adverse drug events and of outpatient prescription visits to calculate the number of ED visits for adverse events from a particular psychiatric drug per 10,000 outpatient prescription visits at which the drug was prescribed.

Almost 1 in 5 of those ED visits (19.3%) resulted in hospitalization. Sedatives and anxiolytics, antidepressants, and antipsychotics each caused 20,000 to 30,000 ED visits annually. However, relative to how often each of these types of medications was prescribed at outpatient visits, antipsychotics and lithium salts were more likely to cause ED visits for adverse drug events than were sedatives, stimulants, and antidepressants. Antipsychotics caused 3.3 times more ED visits for adverse drug events than sedatives, 4.0 times more ED visits than stimulants, and 4.9 times more ED visits than antidepressants relative to their outpatient use.

Out of the 83 specific drugs the study looked at, 10 drugs were implicated in nearly 60% of the ED visits for adverse drug events from therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants. Zolpidem was implicated in nearly 12% of all such ED visits and 21% of such ED visits involving adults aged 65 years or older, more than any other sedative or anxiolytic and more than any antipsychotic, antidepressant, lithium salt or stimulant.

“The study highlights the importance of encouraging doctors to be cautious in their prescribing of medications,” said one of the study’s leaders Lee M. Hampton, MD, of the Centers for Disease Control and Prevention's healthcare quality promotion division. “The study findings can also be used to prioritize efforts to reduce the burden of adverse events from the therapeutic outpatient use of psychiatric medications within a given managed care or healthcare system.”

[...]

Thursday, November 27, 2014

Miami-Area Psychiatric Hospital Chief Operating Officer Christopher Gabel Pleads Guilty in $67 Million Mental Health Care Fraud Scheme

As reported in the Imperial Valley News

The former chief operating officer of a Miami-area hospital pleaded guilty today for his role in a mental health care fraud scheme that resulted in the submission of more than $67 million in fraudulent claims to Medicare by a state-licensed psychiatric hospital located in Hollywood, Florida, that purported to offer both inpatient and outpatient mental health services.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Derrick Jackson of the U.S. Health and Human Services Office of Inspector General’s (HHS-OIG) Florida region made the announcement.

Christopher Gabel, 61, of Davie, Florida, the former Chief Operating Officer (COO) of Hollywood Pavilion LLC (HP), pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and pay and receive health care kickbacks. Gabel was charged in an indictment returned on May 8, 2014.

According to Gabel’s admissions in connection with his guilty plea, between April 2003 and September 2012, HP submitted false and fraudulent claims to Medicare for treatment that was not medically necessary or not provided to patients. As COO during that time, Gabel supervised HP’s staff at both its inpatient and outpatient facilities, where Medicare beneficiaries were admitted to HP regardless of whether they qualified for mental health treatment, and were often admitted before seeing a doctor.

Gabel admitted that HP obtained Medicare beneficiaries from across the country by paying bribes and kickbacks to various patient brokers. Gabel instructed the patient brokers to falsify invoices and marketing reports in an effort to hide, and cover up the true nature of the bribes and kickbacks they were receiving from HP. From 2003 through August 2012, HP billed Medicare approximately $67 million for services that were not properly rendered, for patients that did not qualify for the services being billed, and for claims for patients who were procured through bribes and kickbacks. Medicare reimbursed HP nearly $40 million for those claims.

Karen Kallen-Zury, Daisy Miller, Michele Petrie and Christian Coloma were convicted at trial in June 2013 for their roles in this scheme. Kallen-Zury, HP’s former chief executive officer, was sentenced to 25 years in prison. Miller, the clinical director of HP’s inpatient facility, was sentenced to 15 years in prison; and Petrie, the head of HP’s intensive outpatient program, was sentenced to six years in prison. Coloma, the director of physical therapy for an entity associated with HP, was sentenced to 12 years in prison. Kallen-Zury, Miller and Petrie were ordered to pay nearly $40 million in restitution, and Coloma was ordered to pay more than $20 million in restitution.

The case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. The case is being prosecuted by Trial Attorneys Nicholas E. Surmacz, Andrew H. Warren and L. Rush Atkinson of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: http://www.stopmedicarefraud.gov

Wednesday, November 26, 2014

Regulation needed to curb overprescribing of drugs for children, say advocates

A Report from the LA Daily News

Scrutiny of doctors who prescribe psychotropic drugs to California foster children intensified this week, with growing calls for regulators to consider whether financial relationships with pharmaceutical companies may be driving the excessive use of medication.

The outcry came from a leading consumer advocacy group as lawmakers stepped up their efforts to rein in reckless prescribing and the California Medical Board vowed to widen its investigation in response to this news organization’s ongoing series “Drugging Our Kids.” On Sunday, the news organization reported that prescribers in the foster care system received more than twice as much as the typical California doctor in payments from big drug companies for meals, gifts, travel, speaking and industry-sponsored research. The news organization also found that last year doctors who prescribed the most to California foster youth, on average, accepted almost four times as much as those who fell in a lower-prescribing group.

“We’ve known for years that the problem of drug manufacturer payments to doctors appears to have an outsize influence in their prescribing practices,” said Carmen Balber, executive director of the nonprofit group Consumer Watchdog. “But this investigation was particularly disturbing because of the patients it affects. The conflict of interest is clear in these cases and we think that action is long overdue.”

In a letter to the California Medical Board sent earlier this week, Balber’s Santa Monica-based organization called on the state licensing agency to expand its current investigation of doctors who may be overprescribing to foster youth “to determine if children are inappropriately being prescribed or overprescribed because of drug manufacturer payments to their physicians.” Balber said the prescribing has not only cost taxpayers millions of dollars in payments for possibly unneeded drugs, but has also put the children’s health at risk. The news organization’s report on industry ties, she added, “makes clear that the state has failed to take the steps necessary to protect children.”

Kimberly Kirchmeyer, executive director of the California Medical Board, noted there is no law prohibiting doctors from accepting drug industry promotional funds. The news organization found pharmaceutical companies spent more than $14 million to woo foster care prescribers from 2010 to 2013.

But the payments may constitute “unprofessional conduct,” Kirchmeyer added, and that could warrant additional scrutiny. She said the agency plans to look into whether these doctors “have a reason to prescribe, are they appropriately prescribing, or are they prescribing medication inappropriately to support the pharmaceutical company?”

The medical board has been looking into whether specific doctors are over-prescribing psychotropic medications to foster youth since the news organization published its first installment of “Drugging Our Kids’’ in August, which revealed that almost one in four foster teens are prescribed psych meds. Many of the drugs are being prescribed to control troublesome behavior instead of the severe mental illnesses they are approved to treat. They can have debilitating side effects, such as rapid weight gain, higher risks of diabetes and severe lethargy.

The news organization’s original findings drove state Sen. Jim Beall, chairman of the Senate Human Services Committee, to push for more detailed information from the state Department of Health Care Services on prescribing practices to foster youth.

On Monday, Beall, D-San Jose, met with California’s director of social services, Will Lightbourne, to discuss the request he and Los Angeles Democratic state Sen. Holly Mitchell submitted to health care officials last week.

The two senators have called on Health Care Services Director Toby Douglas to release geographic and demographic information on prescribing patterns, including tallies of foster children on multiple medications and high doses, as well as those being prescribed drugs for conduct “disorders” — more information than the state has been willing to release so far.

Beall said he will use the data to draft legislation aimed at improving the oversight and monitoring of psych medication use in foster care. The bill could require regular reports and analysis of county-level prescribing trends and establish a hotline for lawyers, judges, doctors and other caregivers who need guidance on medication. On Monday, after the news organization’s latest report, Beall said he also wants doctors’ interactions with drug companies to be better monitored.

“The Social Services Agency should take all steps to ensure that there’s no conflict of interest in medical care for any of our foster kids — and if that’s happening right now, we’re going to take action in the Legislature to make sure that doesn’t happen,” Beall said.

State Sen. Ted Lieu, D-Redondo Beach, who in August called for a state investigation into psychotropic drug prescriptions for minors in the wake of the initial series of news reports, echoed the more recent calls by his fellow state legislators to make the additional information public.

“I’m pleased that the California Medical Board had initiated an investigation, but now has expanded it,” said Lieu, who was just elected to Congress. “I believe the investigation by the newspaper has raised some very troubling questions about how psychotropic drugs are being administered to foster youth.”

Marilyn Benoit — the former president of the American Academy of Child and Adolescent Psychiatry and current chair of the academy’s task force that proposed guidelines on relations with drug companies — said the news organization’s unique look at foster care prescribers’ link to drug companies is “concerning.”

“This is a capitalistic country — you’re supposed to market and advertise the products you make — there’s nothing wrong with that,” said Benoit, a child psychiatrist who oversees a Pennsylvania-based behavioral health center that treats foster youth. “But as prescribers, we have to be more scrutinizing and understand the difference between marketing and real scientific information about the medication we use.”

Yet Benoit cautioned that although “research clearly shows that doctors can be influenced by gifts,” her organization is advisory only, and has no enforcement capabilities. She said doctors must take personal responsibility to draw the line. “When you’re tied to the pharmaceutical industry,” Benoit said, “then there could be a conflict of interest in your prescribing behavior.”