Thursday, November 30, 2006

Another Coincidence of a Horrible Death and Antidepressants

Another pesky coincidence, where anti-depressants were used by someone who is alledged to have committed a horrible crime. as reported here:

Just minutes before his mom smothered him to death with a pillow, a 9-year-old Brooklyn boy begged her to "go to the doctor and get help," according to court papers made public yesterday.

"Demom" Olivia Jnnoel, 27, interviewed by detectives in a hospital where she'd been taken after jumping in front of a subway train, told detectives about the last conversation she had with her son, Kanil, on Nov. 13, the papers say.

Following morning prayers in the family home on Brooklyn Avenue in Crown Heights, Jnnoel's fiancé left for work, and mother and son lay in front of the TV, discussing the nightmares they'd each had.

"Kanil tells her that he had a bad dream last night," the papers say. "Being on the Empire State Building and flying. Her son mentioned going to hell . . .

"She then decided that if she was going to kill herself, she was going to take her son with her. That's when Kanil told his mother, 'Mom, you need to go to the doctor and get help.' "

The chilling confession was made public following Jnnoel's arraignment yesterday in the psychiatric ward at Elmhurst Hospital in Queens.

An indictment unsealed yesterday charges Jnnoel with murder, manslaughter and child endangerment for suffocating the boy just a day after his ninth birthday.

Police Commissioner Ray Kelly said after the murder that the woman told investigators that "demons overtook her" - although that was not mentioned in the court papers.

The first interviews with Jnnoel took place at Lutheran Hospital, where she was being treated for injuries sustained when she leaped in front of an F train in Coney Island. "I killed my son," Jnnoel allegedly told them. "I have no conscience."

After finding the boy's body inside the family house, detectives questioned Jnnoel further.

She allegedly told them she'd been under treatment for depression for six months, seeking relief from thoughts of suicide by taking Ambien, Prozac and Neurontin, which is used to treat nerve pain and seizures.

But on the night of Nov. 12, the Prozac bottle was empty, and Jnnoel's sleep was plagued by dreams.

"She awoke with these horrible thoughts in her head to hurt herself and could not stop thinking about it," according to the court papers.

Jnnoel faces 25 years to life in prison if convicted of the most serious charge.

Her lawyer, Jonathan Sims, yesterday requested a mental evaluation. If she's found unfit for trial, she could face an indeterminate period in a psychiatric institution.

Pregnant Women Are Urged to Avoid Paxil

As seen here

Pregnant women and those who plan to become pregnant should avoid taking the antidepressant Paxil if possible because of the risk of birth defects, a group of obstetricians said Thursday.

The opinion issued by the obstetric practice committee of the American College of Obstetricians and Gynecologists comes nearly a year after the Food and Drug Administration and manufacturer GlaxoSmithKline reclassified the drug to reflect studies in pregnant women that showed the drug poses a risk to the fetus.

Two studies of pregnant women who were taking Paxil during their first trimester have shown that their babies have heart defects at a rate that is as much as twice the norm, the FDA said at the time.

The American College of Obstetricians and Gynecologists also said the decision whether to treat pregnant women with SSRIs, a class of antidepressants that includes Prozac, Zoloft and Lexapro as well as Paxil, should be considered on an individual basis.

Exposure to SSRIs late in pregnancy has been associated with short-term complications in newborns
, the doctors said.

However, reproductive-age women have the highest prevalence of major depressive disorders. The benefit to the mother of treatment with any of the drugs may outweigh the risk to the fetus.

The opinion appears in the December issue of the journal Obstetrics & Gynecology.

On the Net:

American College of Obstetricians and Gynecologists:

Exercise in Children Leads to better Sleep and more Focus, Study Says

Another Condition Misdiagnosed as ADHD. But make the kids exercise?

A new study shows definite results that exercise for overweight children can help reduce snoring, hence improving sleep quality, attention span and focus.

Snoring is associated with poor sleep quality, which can lead to learning and behavioral problems that are often mistaken for disorders such as ADHD, says Dr. Catherine L. Davis of the Medical College of Georgia in Augusta.

Furthermore, prescribing stimulant ADHD drugs, like Ritalin, to kids who aren’t sleeping well will only make matters worse, she added. She also noted the growing evidence that sleep disorders can lead to a great risk of being overweight.

To research whether exercise might reduce sleep-disordered breathing in overweight kids, Dr. Davis and her team randomly divided 100 overweight children in the 7-to-11 age group between three different control groups. For the 13 week study period, the “high-dose” exercise group were involved in 40 minutes of physical activity every school day, the “low-dose” group exercised for 20 minutes a day and the third control group did not perform additional exercise.

The workouts consisted of games like basketball and tag, but unlike traditional gym class, Davis noted, there was no standing around waiting to play or be picked — the children were on the move for the entire session.

At the beginning of the study, one quarter of the participants’ parents reported symptoms in their children, such as snoring and inattention, serious enough to indicate a problem. Currently, just 2 percent of all children are thought to have sleep-disordered breathing, Davis and her colleagues note in the current issue of the journal Obesity.

By the end of the study period, half of the children who snored and were assigned to one of the exercise groups had stopped snoring altogether. Greater improvements were seen among the high-dose exercisers. However, weight, fatigue and behavior did not change.

Exercise alone is generally not enough to help people lose weight, Davis noted, although it does help people become more fit, physically and mentally, in every aspect. It’s possible that the workouts helped reduce the fat surrounding the neck area that can lead to collapse of the airway during sleep, she added, while exercise may also have had metabolic or neurological effects that made the brain, nerves and muscles better able to maintain an open airway.

To get the same amount of exercise in the real world, the children would probably need to exercise for an hour each day, Davis said. She recommended that parents send their kids out for some exercise right after school. Allowing them to burn off pent up energy will likely improve their mental focus and ability to tackle homework afterwards, she said.

Attention woes addressed without use of medication

Several points:

  1. It's wonderful that more people are looking at non drug options for this 'condition'
  2. There is still a major issue to what is the actual condition that is being treated.
  3. So much of this disease lies in the realm of being 'socially defined', in the sense that it is behavior that is not acceptable to the current run of the mill teacher, who does not have the time or energy to deal with these kids.
  4. God forbid that the condition, like autism, should be found to be a side effect of some common aspect of modern life. Like Television.
As seen here.
"She's been having problems with staying focused," said her mom, Nancy Lewis of Marysville.

The school, Bible Baptist in Shiremanstown, didn't seem like an issue. It doesn't have a disruptive atmosphere.

So it came back to the 12-year-old and what is often described as Attention-Deficit Hyperactivity Disorder _ a persistent pattern of abnormally high levels of activity, impulsiveness or inattention. The answer is usually Ritalin.

Nancy Lewis thought there might be a better way.

So twice a week, Sierra straps on a bike helmet that measures brain waves, and she works with video games that challenge her to pay attention.

"Kids who really have attention problems, they don't know what it feels like to pay attention," said G. David Smith, psychologist and president of Riverside Associates on Green Street, where Sierra has been going since July. "We teach them self-awareness and self-management, and not to be dependent on medication or on other people."

Smith and behavior specialist Katie Manning use the video software to teach their clients focusing skills, which the children can then transfer to the classroom and elsewhere.

To be nice, they call the video software a game.

"Play Attention" is a virtual reality system with a helmet attached to a computer. It's a difficult reality. Some of the games don't start until the helmet registers the brain waves that indicate the child is paying attention.

"The system projects that on a screen so kids can see when they hit it, and then use that as a way to get themselves in gear," Smith said.

The training techniques were developed by researchers working with brain injuries, particularly those of the frontal lobe, which Smith says mimics ADHD.

"These injuries produce problems in what are called executive functions, which have to do with planning, understanding cause-and-effect relationships and withholding the impulse to act," he said.

The video training teaches the children to focus on a shape as it moves around the video screen, for instance. It also helps them control their impulses by requiring the child to respond with a click of a button to certain images.

During the video sessions, Manning notes disruptive behaviors on a checklist and programs them into the virtual reality system to show how fidgeting or looking around the room interferes with the ability to focus.

The skills are eventually applied to real situations such as doing homework.

"We try to incorporate the school as much as possible," Manning said.

They also imitate home situations, which will help the children apply the acquired skills when their parents give them instructions to do something

"We never ask a kid to do something we think he can't do. It's almost like lifting weights. You get the kid lifting comfortably, then you add a pound. Not 10," Smith said. "The idea is to teach the kids that they can do this and they can use these skills, and generalize these skills."

These days, Sierra Lewis is able to ignore the chatter of her classmates and ambient noise that used to bother her. Her report cards are improving.

"We thought we'd try this program and see if it would help her to concentrate," her mother said. "I think it has. She does very well with the program."

The Riverside training system is currently working with about eight children, and it has worked with 20 or so in the past six years.

Smith is authorized to provide the treatment to children on Medicaid. Otherwise, the program costs $55 a session or $2,600 for the course.

"Insurance companies won't pay," Smith said. "They'd rather pay for medication."

Mental Health Abuse and Neglect in Missouri

A St. Louis Post-Dispatch investigation has found abuse and neglect of mentally retarded and mentally ill residents in state centers and in private facilities the state supervises. Since 2000, there have been more than 2,000 confirmed cases of abuse and neglect with 665 injuries and 21 deaths. This investigation was published over a 4 day period, with many graphics, interviews, and additional information documenting the horror story. And it is all available online here

Missouri Task Force Recommends Investigating Abuse, Neglect, and Deaths in State Mental Health Facilities

From the Springfield News Leader

The state should establish a board to review the deaths of adults in state mental-health facilities, a task force recommended Wednesday in a report that made no mention of improving fire safety.

The report comes days after a fatal fire at the privately run Anderson Guest House, a residential care facility licensed by the state Department of Mental Health.

The task force focused many of its 25 recommendations on improving the procedures for reporting abuse and neglect in state- operated facilities after a newspaper series detailed abuse problems in these facilities.

The eight-member panel crafted its recommendations upon gathering public testimony at hearings across the state, including one this summer in Springfield.

"We never heard one word from any of the 271 witnesses about fire safety," said Lt. Gov. Peter Kinder, task force chairman.

The panel calls on the Department of Mental Health to:

- Pursue accreditation of its six habilitation centers and community providers that serve people with developmental disabilities

- Ensure staff are trained on identifying and reporting abuse and neglect

- Increase penalties for failure to report abuse and neglect

- Establish a mental-health fatality review board

- Allow access to nonconfidential information in substantiated abuse and neglect investigations

Gov. Matt Blunt formed the task force in June. In August, the panel heard southwest Missourians voice concerns about the safety of family members in state mental-health centers.

"These recommendations represent what Missourians told us they wanted for the state's mental-health system," Ron Dittemore, interim director of the Department of Mental Health and task force co-chairman, said in a statement.

Earlier this year, the St. Louis Post-Dispatch reported 21 deaths were linked to abuse and neglect at state-affiliated centers. The series revealed a flawed system of reporting and oversight.

State Auditor and U.S. Sen.-elect Claire McCaskill has called for more oversight for these facilities in a handful of state audits.

Though the Anderson Guest House holds a Department of Mental Health license, the state Department of Health and Social Services performs routine inspections.

That agency is supposed to inspect twice a year, but budget cuts have allowed for only annual reviews, a spokeswoman said.

Kinder said he expects the legislature will review the department's budget in the upcoming legislative session to restore funding for inspections.

Reviews of the Anderson Guest House in March 2006 and December 2004 revealed no deficiencies in fire safety. The nonprofit Joplin River of Life Ministries operates the center.

"This facility, as far as we know, was compliant with existing fire safety regulations," Kinder said. "We along with everyone else in state government will be looking and looking again at measures to improve fire safety."

One measure that took effect in August mandates an automatic sprinkler system for assisted living facilities. As a residential care facility, the Anderson Guest House does not fall under these regulations.

Advocacy groups have called for sprinklers to be installed in long-term care facilities. The one-story home had a fire alarm system but no sprinklers, which was not required by the state.

"The costs are enormous to install sprinklers in older buildings," Kinder said. "I'm not saying I'm against it. That's why it has not been done to date. As we learn more about the cause of this fire and how it spread, we can all review."

Wednesday, November 29, 2006

Drug death party psychiatrist admits substance misuse

As seen here, a followup from this earlier report on this site.

The psychiatrist who hosted a party where a man died from an overdose has admitted that he also used class A drugs.

Dr Clint Tatchell, who specialised in addiction therapy, has denied inappropriately supplying pills to his friends at the Roman-themed event at his luxury Glasgow flat.

The General Medical Council has been told that David Steel, 30, overdosed on ecstasy at the toga party.

Dr Tatchell, 37, who worked for NHS Greater Glasgow, also denied claims that he lied to police and hurriedly tidied the flat before detectives arrived to investigate his friend's death in September 2003.

Officers later discovered Mr Steel had taken a cocktail of drugs including diazepam, ecstasy, heroin and cocaine.

Dr Tatchell claimed there were no illegal drugs in his Spiers Wharf flat on the night of the party, but admitted he had taken ketamine, a horse tranquilliser, on nights out with Mr Steel before his death.

Dr Tatchell said: "Obviously one of the topics which did come up with us getting to know each other was about our drug experiences. We spoke openly and freely about it.

"In narrating these stories and experiences with mind altering substances, David Steel did tell me about ketamine and its use as a recreational drug.

"I remember explaining the medicinal uses and he did explain the recreational use and the effect one gets from it.

"From what he described, the effect of the ketamine sounded very much like the euphoria that I had experienced when I had experimented with ecstasy, but it did not seem to have the same side effects."

Dr Tatchell admitted he became "curious" about trying ketamine and even researched it on the internet. "I do admit that I did use it on a few occasions with David Steel. On all occasions when we used it was usually in a clubbing environment because that was the only avenue David Steel had.

"He told me how to purchase it, there was one club in particular in Glasgow where you could get it if you wanted to use it."

Dr Tatchell admitted to the panel that he had taken ecstasy and cocaine while working as a model in the Netherlands for 18 months in the early 1990s.

He claimed he stopped because it gave him a sore tongue and anxiety attacks.

Dr Tatchell said he decided to give up ketamine completely because of a "moral dilemma" he faced when he was offered a post with NHS Greater Glasgow. He added: "I did have a dilemma with regard to using a mind-altering substance and working in a field where I was actually dealing with a group of society that was abusing it."

Before working for the trust, Dr Tatchell worked at the exclusive Priory rehab clinic in Glasgow. He told the panel there were no drugs at his flat during the party, which started out as a night out in a Glasgow gay bar and turned into a three-day bender.

He said: "I was not aware of any drug-taking in my flat."

The psychiatrist trained in Johannesburg, South Africa, and practised in addiction psychiatry for NHS Greater Glasgow between 6 May, 2003, and 31 July, 2004.

Dr Tatchell denies his fitness to practise is impaired.

The hearing continues.

'We want real doctors not spin doctors’

As seen in this report

An NHS body is offering to pay more than £90,000 a year to a PR guru - despite the threat of 500 job losses in Times Territory.

The East of England Strategic Health Authority is offering a salary range of £80,000 to £90,000 for a director of communications, with "more available for exceptional candidates".

This figure is nearly FIVE times the starting salary of a newly-qualified nurse, who can expect to earn a little over £19,000 a year.

The SHA is one of 10 new bodies created in England earlier this year and oversees the work of primary care, hospital, ambulance and mental health trusts in the region

The news comes amid the threat of redundancy for hundreds of staff who work at the QE2 and Lister Hospitals.

A spokesman defended the salary, saying: "Communications is a vital task in the NHS.

"This is an important post, the role of which is to ensure good and effective communications between patients, public and the different parts of the NHS across the region.

"The salary for this post is in line with similar jobs in the public sector. Salary ranges are set according to a range of factors including responsibility levels and market forces."

But Welwyn Hatfield MP Grant Shapps hit out at the figure, branding it "absolutely outrageous".

He said: "People in Welwyn Hatfield will be appalled to hear of this. We want real doctors, not spin doctors.

"Because we've been betrayed over the pledge of the Hatfield superhospital, this money would be much better spent in keeping open maternity, A&E or any of the other departments under threat of closure at the QE2."

- North East Herts MP Oliver Heald was also critical.

He said: "At a time when 1,000 jobs in Hertfordshire in the NHS are threatened, it seems incredible that the priority of the strategic health authority is to bring in highly paid spin doctors."

- Labour MP Barbara Follett, whose Stevenage constituency includes Knebworth and Codicote, blamed the need for the post on the media.

She said: "Good, clear communication between the regional health service and the public is absolutely vital.

"Without it we get the kind of scare stories that have been appearing in our local press recently.

"Good communicators do not come cheaply but the salary for this post is in line with similar ones in the public sector.

"I wish such posts were not necessary. Perhaps if our press were more responsible they would not be.
Maybe they need someone to explain their screw-ups?

Eli Lilly, ZYPREXA, and Diabetes

As seen in this column

How does zyprexa cause diabetes?

What occurs is there is a TEN times greater incident of becoming a type 2 diabetic from zyprexa. The prevailing theory is because it causes weight gain which itself is a precursor for diabetes AND more sinister it may actually poison the pancreatic beta cells killing them off.

I took zyprexa starting in 1996 the year the FDA approved it, which was ineffective for my condition and gave me diabetes.

Zyprexa is the product name for Olanzapine, it is Lilly's top selling drug.It was approved by the FDA in 1996, an 'atypical' antipsychotic a newer class of drugs without the motor side effects of the older Thorazine. Zyprexa has been linked to causing diabetes and pancreatitis.

Zyprexa, which is used for the treatment of psychiatric disorders, such as schizophrenia and bipolar disorder, accounted for 32% of Eli Lilly's $14.6 billion revenue last year.

Did you know that Lilly made nearly $3 billion last year on diabetic meds, Actos, Humulin and Byetta?

Yes! They sell a drug that can cause diabetes and then turn a profit on the drugs that treat the condition that they may have caused in the first place!

I was prescribed Zyprexa from 1996 until 2000.

In early 2000 i was shocked to have an A1C test result of 13.9 (normal is 4-6) I have no history of diabetes in my family.

All the psychiatrist I've interviewed and the information on line presents zyprexa as a worse offender than the other Atypicals such as seroquel.My doctor has stopped prescribing zyprexa altogether.

The PDR classifies zyprexa as 'severe' for causing weight gain and diabetes and seroquel as 'moderate'.

Of course the 50 year old Thorazine didn't cause diabetes and is many times cheaper but it could cause tardive dyskinesia.

Where Eli Lilly's negligence comes in, is their KNOWING and not informing consumers (black box warning) until the FDA demanded it.

Lilly's incentive not to readily disclose is they had billions coming in from state medicaid scripts.

Tuesday, November 28, 2006

Criminal Probe Launched in Fire That Killed 10 in Missouri Mental Health Home

As seen on Fox News

State fire investigators were trying to determine Monday whether a fast-moving early morning blaze that killed 10 people and injured two dozen at a southwest Missouri group home for the elderly and mentally ill was deliberately set, Gov. Matt Blunt said.

"We're not saying it is definitely a crime scene, but we are treating it as if it is and trying to determine if the fire was set by somebody who had a nefarious motive," he said.

"It is being treated as a suspicious fire," he said, without elaborating about potential evidence.

Supervising Investigator Bill Zieres with the Missouri Fire Marshall's Office tells Fox News officials have pinpointed the ignition point in the northeastern part of the building. Zieres says they've found no physical evidence so far to indicate the fire was deliberately set. Zieres adds nothing has been ruled out and investigators are trying to keep an open mind to any possibility.

One thing investigators are checking out is a gas furnace and electrical wiring in the part of the building where the fire started.

Zieres says firefighters got on the scene very quickly but had a difficult time getting control of the fire, which quickly chewed through the wood roof of the building.

The home had fire alarms but no sprinklers, said Assistant State Fire Marshal Greg Carrell.

One of the dead was a worker in the home and the other nine were residents, Blunt said. Authorities had not yet released the names, pending notification of relatives.

"I saw the front door blow open with fire," said neighbor Steven Spears, 47, who was watching TV and saw the blaze erupt through security cameras stationed outside his home. "I know most of them (the residents). I've talked to all of them at one time or another. It still hasn't hit me."

The home is operated by Joplin River of Life Ministries Inc. A woman who answered the phone there said the firm would not immediately comment but might release a statement later Monday.

The dead ranged in age from early 20s to the elderly. Eighteen people were taken to area hospitals and six were treated at the scene. The home had 32 residents and two employees inside when the fire was reported around 1 a.m., Highway Patrol spokesman Kent Casey said.

Two people were in serious condition at a Springdale, Ark., hospital. Freeman Hospital West in Joplin would not release the conditions of four people sent there after the blaze. All the other survivors who went to area hospitals were either in good condition or had been treated and released.

Officials were refusing to say how the victims died or whether they had warning. Blunt also said authorities were still investigating whether the home's residents were in bed when the fire began.

Asked if two staff members were enough to look after 32 residents, Blunt said that was up to state health officials.

"Again, it was late at night," he said. "That would impact to some degree the amount of care that is necessary."

There also was no information to suggest any of the victims were originally from Anderson, a town of mostly small businesses and manufacturing and whose residents commute roughly an hour south to Wal-Mart headquarters in northwest Arkansas or the businesses that have sprung up around the retailing giant.

On Saturday, there was a mattress fire on the other side of the building. No one was injured in the first fire, which was still under investigation when the second blaze began. Investigators say there's nothing to indicate that the deadly blaze was a rekindling of the earlier fire.

Inspectors from the Missouri Department of Health and Senior Services, which licenses the facility, found some deficiencies at the home in March but none related to fire safety, agency spokeswoman Nanci Gonder said.

"This is a devastating situation and we express our sympathy to the families of those who were killed or injured in the fire," Gonder said in a news release.

The deaths were the most from a single blaze in Missouri in recent memory.

"It's terrible," Casey said. "I have never been involved in a fire in which 10 people lost their lives."

The home is a residential care center licensed by the Missouri Department of Health and Senior Services. The facility also has a license from the state Department of Mental Health that allowed mentally ill residents to live at the home and receive treatment elsewhere.

The facility was cited in March for grease buildup in the kitchen, uncovered fluorescent light fixtures, allowing meat to thaw on the kitchen counter instead of in a refrigerator, allowing a resident to take more than the prescribed dose of an inhaler and not requesting criminal background checks as quickly as required by law for new two new employees. All the deficiencies were corrected within three weeks, according to the health department.

In 2003, a patient suffering from dementia and multiple sclerosis, set fire to her bed and burned down the Greenwood Health Center in Hartford, Conn., killing 16 residents. Six months later, in September 2003, a fire killed 15 patients in Nashville, Tenn.

Psychiatrist banned for patient love affairs

From this Australian Report

A leading Melbourne psychiatrist who was suspended for an affair with a patient has been banned from practice again after he was found to have lied under oath to cover up a second sexual relationship.

Ian McColl Fitzgerald — once described as "one of Victoria's best psychiatrists" — was suspended for five years at a hearing of the Medical Practitioners Board yesterday after admitting a two-year sexual relationship with a severely depressed woman who was having suicidal thoughts and hearing voices.

The father of four had been disciplined by the board in 2001 for a relationship with another vulnerable patient that lasted nearly three years.

Giving evidence at the 2001 hearing, Fitzgerald vowed never to repeat his offences — but at the time he was almost one year into the relationship with the second patient.

At yesterday's hearing, the three-member panel found Fitzgerald guilty of unprofessional conduct of a serious nature, and infamous conduct in a professional respect.

Counsel assisting the board, Melanie Young, said the woman, who began the relationship with Fitzgerald in January 2001, was quite ill and suffering a sense of persecution and hopelessness about her life.

"She was severely depressed and had been diagnosed with borderline personality disorder," Ms Young said. "Her marriage had broken down, leaving her a single mother with a young child."

She said Fitzgerald ended the affair with the first patient in November 2000 and began a sexual relationship with the second woman in January 2001.

After suffering from depressive symptoms, he stopped working at his Melbourne practice in September 2001 and appeared at a hearing in December that year to answer allegations about the first affair.

Ms Young said Fitzgerald had told the board in 2001 that he was remorseful and "deeply distressed and humiliated" by his actions.

"He gave evidence on oath to the panel that he had never had a relationship with another patient and that he never would have a relationship with another patient," Ms Young said. "He also gave evidence that he knew this relationship with the first patient was wrong … but what he didn't tell the panel was that he was already involved in a second relationship with a patient on that very day."

Counsel for Fitzgerald, Fiona Ellis, said several factors leading to her client's first affair were also relevant to his second relationship. He was depressed at the time of starting the new affair and suffering the effects of an acrimonious marriage breakdown in 1997. He faced bankruptcy, was stressed at work and "completely cleaved by grief" at being separated from his four children.

Prior to ending the relationship in April 2003, he had been diagnosed with type 2 diabetes, stopped taking his antidepressant medication and enrolled in a postgraduate diploma in professional ethics.

Ms Ellis said her client's "pathological vulnerability" and "neediness for emotional relations" obscured his professional judgement.

In a letter Fitzgerald had sent his children, he said: "I've made horrible mistakes, not simple transgressions of ethicism but errors of judgement … I failed the test and I didn't even realise I was in the exam room."

Monday, November 27, 2006

Warning to Psychs: How would your practice records look to the FBI?

As sen in this report

Until recently, a psychologist in a Southeastern state had a thriving practice in geriatric psychology, working with patients in nursing homes. Then the health-insurance company that acts as the Medicare carrier for his state had his records audited.

The report of that audit said that several dozen patient records had been reviewed and all of them lacked sufficient documentation to indicate medical necessity. This "sampling" of records, according to the audit procedures Medicare uses, could represent all the work he had done in the nursing homes during that period--a methodology that APA and health-care providers in general vehemently oppose since it can lead to inappropriate assumptions and faulty conclusions.

Rather than questioning the few thousand dollars of claims represented by the files reviewed, the agency extrapolated to cover all his claims over the entire time period and said the psychologist had over billed by more than $500,000.

The FBI then moved in with a search warrant, seized all of his records, apparently for the purpose of a criminal investigation.

The psychologist now has an attorney and is appealing the Medicare agency's decision to an administrative law judge. His attorney asked that neither the psychologist nor himself be identified pending the legal proceedings. The FBI has not indicated whether a criminal prosecution is in the works.

After the audit, Medicare, his primary reimbursement source, suspended all payments to him.

The government's massive initiative against health-care fraud and abuse in this country is several years old, now a permanent structure and one that is expanding, according to sources in Congress, federal agencies and private consultants.

APA's Practice Directorate has monitored developments related to the enforcement push over several years.

"While the APA supports efforts to eliminate fraud and abuse in the current health-care system," said Russ Newman, PhD, JD, APA's executive director for practice, "we are similarly concerned that overly zealous fraud enforcement not cast an inappropriately wide net. The directorate is aware of many instances where Medicare carriers are using enforcement policies as cost-containment devices to curtail legitimate services."

Others working with practicing psychologists confirm that assessment.

"This is a freight train coming at psychologists," says James Georgoulakis, PhD, MBA, APA's representative to the Resource Value Update Committee that advises the Health Care Financing Administration (HCFA).

Virtually every week he gets a call from a psychologist under investigation. Accusations of over billing from $60,000 to $100,000--often more than a practice can sustain--are not uncommon, he says.

Up to now psychologists have not been scrutinized as intensely as hospitals and physicians, says Georgoulakis, director of healthcare, Holt Companies, San Antonio, Texas, and author of several books and articles on health-care compliance.

The bad news, he says, is they are vulnerable to future pressure that could be much greater.

"It's not that psychologists are dishonest people. It's that we are not educated on claims submission," he says.

Psychologists are getting in trouble, says Georgoulakis, with coding, indications of medical necessity, poor documentation, bills indicating too many hours for one day, and lack of knowledge of payment policies.

Enforcement actions can range from demands for reimbursement to civil penalties and, in some cases, even the possibility of imprisonment.


An intensified push

In recent years, Congress has pumped hundreds of millions of new dollars into the health-care enforcement effort. Much of that mandated enhancement has only recently been coming to fruition.

Attorney General Janet Reno has declared combating health-care fraud and abuse the second highest priority in the U.S. Department of Justice (DOJ), preceded only by the fight against violent crime. The HCFA budget for the effort this year is over $700 million. The battle is being carried out by the "fiscal intermediaries" and "carriers" for Medicare, state Medicaid fraud units and the DOJ's U.S. attorneys' offices around the country.

And just in the last year, HCFA has expanded the avenues of attack by funding new "program safeguard contractors" to be more focused, aggressive fraud fighters than the regular Medicare carriers and fiscal intermediaries. In addition, it mandated that the federal "peer-review organizations" in every state devote more resources to claims review.

The largest part of the antifraud effort still emanates from the federal and state governments, but private insurers have their own efforts. They also coordinate with and learn from the government's efforts.

And this ever-evolving force is not likely to dissipate any time soon, since it's motivated in great part by the pressing need to contain health-care costs, as congressional hearings and agency publications indicate. Various estimates say 7 percent to 10 percent of health-care expenditures are lost to fraud or misbilling.

Hospitals have probably been hit hardest by the enforcement push and they have come to realize that it's not just providers who are intentionally cheating who feel the heat. Most hospitals in the country have had to deal with one enforcement action or another.

And apparently psychologists who are not intending to defraud anyone are getting in trouble as well. As one example, some psychologists are not documenting correctly or in the way prescribed by the local Medicare carrier or fiscal intermediary or other insurer, say Georgoulakis and others. Medical records professionals have a saying, "If it isn't documented, it didn't happen." And if it was billed to an insurance program, say enforcement agencies in legal actions around the country, it's fraud.

Assistant U.S. attorney James Sheehan, the most prominent DOJ prosecutor in health-care fraud, has frankly indicated that the enforcement push is intended not only to root out criminals, but to change health-care practitioners' mindsets through the entire industry. Rather than seeking ways to gain maximum reimbursement, practitioners should be aiming for meticulous compliance with the rules, enforcers emphasize.

Enforcement tools

And enforcement agencies are using hefty instruments to make their point. Other than criminal prosecutions, their primary weapon is the False Claims Act, which makes anyone who submits a false claim to the government liable for a civil penalty of between $5,000 and $10,000 for each claim, plus up to three times the amount of damages.

Although enforcers say these punishments will not be used for inadvertent errors, they can be used when a provider should have known the rules on claim submission or other activity.

Another technique investigators use is the "sampling process," such as the one used in the psychologist's case outlined above. An audit looks at what is intended to be a statistically valid random sample of records. If there are problems in those records, the agency extrapolates that percentage to cover the similar records for the same time frame, multiplying by many times the amount the government says was improperly billed. The amounts can be devastating, even if the enforcement agencies are not seeking penalties.

Although the health-care industry has objected strenuously to the sampling process, courts have upheld it in general, and the government investigators are using it regularly. Attorneys in health-care fraud and abuse indicate it can still be challenged in court in some instances.

The enforcement actions have come in waves, as the DOJ, HCFA and the Department of Health and Human Services Office of Inspector General (OIG) focus on one aspect of the industry or one particular practice and teach each other where the vulnerabilities are.

In terms of psychologists' individual or group practices, Georgoulakis says the distress calls he receives come from all over the country, but most are from New York, Texas, Florida, California and Washington, with some concentration in Ohio and Illinois. He warns that just like with initiatives against hospitals, enforcers will perfect their technique and use it in other regions.

In addition, there are several trends of enforcement actions on services in institutions. A focus on nursing homes is not a surprise, given the finding by the OIG that 32 percent to 46 percent of mental health services in nursing homes are unnecessary.

For example, as of December the Ohio Psychological Association (OPA) had documented 12 cases of Medicare auditors ruling that large portions of a psychologist's services to nursing home patients were undocumented or medically unnecessary. OPA has said the audits did not follow the published policy on medical necessity. The Medicare carrier has said they did.

In another thrust, over the last two years the OIG has found extensive, deliberate fraud involving Medicare's partial hospitalization program in a number of community mental health centers.

The OIG is continuing the investigation into community mental health centers and has moved to investigate partial hospitalization services in hospitals as well as hospital outpatient psychiatric services in general.

In one of the first major such investigations, last year the OIG audited outpatient psychiatric services of Franklin Medical Center of Greenfield, Mass., and found that of $20,871 from 100 random claims, $13,000 was for services not meeting Medicare criteria. From that, OIG projected the hospital owed more than $600,000 in repayments. Problems cited included documentation for group therapy that consisted only of checking off the patients' names; therapists' notes that could not be located; and no documentation of physician's order.

Sidney Rocke, JD, APA special counsel and formerly a health-care prosecutor with the OIG, points out that some psychologists are taking preventive action. Rocke has given continuing-education sessions on compliance for two state psychological associations as a service from the APA Practice Directorate.

"Knowledge is the best line of defense. And that includes psychologists knowing how their practices are vulnerable to attack from both the government and insurance companies."

The Prozac question

An OdEd peice from the Frederick News Post

Prozac is a brand name for fluoxetine, a drug primarily used to treat conditions such as depression, eating disorders, premenstrual mood disorder and anxiety disorders.

Fluoxetine stimulates the brain's levels of the neurotransmitter serotonin; inadequate amounts of that chemical are linked to depression. The medicine blocks unused serotonin from being absorbed by a nerve cell, sending it to another nerve cell and facilitating transfer of the chemical along the brain's synapses.

At first, the drug was heralded as a wonder treatment, with Newsweek giving the pill cover story treatment on March 26, 1990, titling one article "The Promise of Prozac."

But Benjamin Garris wasn't alone in believing something was wrong while he was on Prozac. Long before he consumed the drug, a grassroots movement spread a message that Prozac made people worse -- specifically, more violent and suicidal.

In 1989, Joseph T. Wesbecker killed eight of his co-workers and injured 12 others with an assault rifle before killing himself in Louisville, Ky. Mr. Wesbecker was taking Prozac. The drug's manufacturer, Eli Lilly, reached a settlement over the effects of the drug when a lawsuit was filed on behalf of the people killed by Mr. Wesbecker.

The scientific community also began to weigh in. In the March 1991 edition of the Journal of the American Academy of Child and Adolescent Psychology, researchers from the Yale University School of Medicine described how six out of 42 patients ages 10 to 17 with a history of psychological problems worsened while being treated with fluoxetine.

On Sept. 20, 1991, about three years before Garris was prescribed Prozac, the Department of Health and Human Services, Public Health Service of the Food and Drug Administration met with the Psychopharmacological Drugs Advisory Committee in Rockville.

The purpose of the meeting: To hold a "scientific investigation into suicidal ideation, suicidal acts, and other violent behavior reported to occur in association with the pharmacological treatment of depression."

Although all makers of antidepressants were invited to the meeting, only Eli Lilly sent representation.

A clear divide developed during the session.

The committee heard stories from people about how they or their friends or relatives changed while under the influence of Prozac and antidepressants:

"After being on Prozac for 21 days, my wife shot and killed both of these two boys right there. She turned the gun to herself and shot herself twice. Now she's in jail for murder. This is the kind of lady that never took a drug, no mixed drinks, no alcohol, no reason to be depressed, just some nerve problems, like everybody else from time to time."

However, members of the professional psychological and psychiatric community said they believed introducing a warning system or other punitive measures for anti
depressants would pose a serious risk for the larger community of people who are stricken with depression:

"We have certainly heard some very sad, troubling, and tragic stories and anecdotes this morning. We also know that when depression is untreated, some 15 percent of patients will kill themselves, additional tragedies, and many more suffer from untreated depression who do not suicide. But depression is eminently treatable. Once recognized and appropriately managed with combinations of pharmacotherapies and psychotherapies, the vast majority of individuals with depression can be treated effectively and lead useful and productive lives."

Representatives from the U.S. Food and Drug Administration and Eli Lilly testified that studies and trials of Prozac, which they said encompassed more than 8,000 patients, showed only a small number of adverse events and no direct connection between increased suicide or violent risk.

"Taken all together, with these anecdotal data one has to raise the obvious question. It seems likely that what we have here is a situation that we are taught in medical school," said Dr. Charles Nemeroff of Emory University, on behalf of Eli Lilly. "Things can be true, (or) true and unrelated. Patients can be suicidal, patients can be being treated with an antidepressant, yet there is no cause-and-effect relationship.

"At best, these are anecdotal reports."

In the end, the committee agreed with Eli Lilly, the FDA and the medical community, voting that no credible evidence supported a conclusion that antidepressants cause or increase suicidal or violent behaviors, and no labeling change should be made.

In September 2004, the FDA approved a warning label for antidepressants, including Prozac. The warning states the drugs can cause suicidal actions in patients under the age of 18.

Handling of ADHD students criticised

Maybe the drugs really weren't needed in the first place. As seen in this story from Australia

Schools could be failing students suffering from Attention Deficit Hyperactivity Disorder by treating them as backward, when a focus on their academic and social needs could wean them off their dependence on medication.

Sufferers of ADHD - the most commonly diagnosed psychiatric disorder among school-aged children in Australia - say teachers were often "quite condescending", treating them like toddlers or primary school students requiring remedial education.

The first study of its kind in Australia, which is to be included in Brenton Prosser's new book Seeing Red, found those students receiving traditional treatments deal with the disorder through school and adult life by relying purely on medication.

"They talked about how they feel the stigma of the label from the media, and that while they need support from school they also don't want to be labelled, in their words, as 'psycho'," said Dr Prosser, a lecturer on ADHD in schools at the University of South Australia.

"The problem is that it's not that young people with ADHD don't understand school-work, it's that schools don't understand how the students work."

The treatment of ADHD with dexamphetamines such as Ritalin has soared in recent years, with about 80,000 young people diagnosed with the disorder.

Dr Prosser said traditional teaching strategies such as remedial intervention were not viewed as successful in engaging ADHD students or supporting their learning needs, and could often lead to resistance.

He said this neglect of students' academic and social needs during primary school years often resulted in significant difficulties emerging in the middle years of school.

Schools and teachers could reduce the pressure on young ADHD sufferers by ensuring, for example, that students with hyperactivity problems did not sit tests after recess or lunch-break, when they have been out in the schoolyard.

Students who had only received medication in primary school also struggled when they came up against the greater social and academic demands of secondary school.

"It's about saying pills don't give you skills," Dr Prosser said.

"Those students who didn't have support, who had only medication, tended to say they had significant problems with ADHD and they were still grappling with adult ADHD and felt they strongly needed the medication to survive through schooling and get through life."

By contrast, students who had received support told Dr Prosser about "growing out of ADHD".

Filth and shame in an NHS hospital

In Briatain, it's not just the Psychs, although I too easily suspect they are leading the pack. As seen in this editorial on mixed sex hospital wards in Britain.

Twenty-four hours to save the NHS! I wonder how often that promise comes back to haunt Tony Blair 10 years later. Week after week reliable reports and the government’s own figures tell a disgraceful story of incompetence, debt, misery and filth in the National Health Service. That story is supported, week after week, by heart-rending personal accounts of horrors on the wards.

The broken new Labour promise that caught most public attention last week was the failure to abolish mixed-sex wards. Janet Street-Porter, the ferocious media personality, wrote about the misery of her sister when dying of cancer in a mixed-sex NHS ward. Plenty of other people have tried to draw attention to this disgrace and Baroness Knight, the Conservative peer, has been campaigning about it for years but — such is the spirit of the times — it takes a loud-mouth celebrity to get public attention.

The same thing happened when Lord Winston made a fuss about the dreadful treatment that his elderly mother received in hospital. Only then did the government stop denying that there was anything wrong.

Street-Porter published extracts last week of the diary of Patricia Balsom, her dying sister. They were horrifying. Among the miseries she endured was lying neglected in a mixed ward, where she was woken more than once to see a naked male patient masturbating opposite her bed. Her shocking stories prompted a flood of others.

The late Eileen Fahey, for instance, dying of cancer, was put onto a mixed geriatric ward where confused people wandered about without supervision. One man with dementia regularly masturbated at the nurses’ station and tried to get into women patients’ beds; he was a threat to them all but staff took no notice, according to her daughter Maureen. Other patients have to give answers to intimate questions in the hearing of other patients. One deaf old man was repeatedly asked when he last had an erection, until tears ran down his cheeks.

A former midwife described eloquently on Radio 4 the indignities of being in a 24-bed mixed-sex ward, stripped of all dignity and intimidated. Bedlam was the word she used, and it applies even more accurately to the secure psychiatric mixed ward in London endured by Susan Craig last year, after a breakdown. She suffered regular sexual harassment, with mentally ill men groping her and exposing themselves. The nurses disbelieved her and told her husband she was “flaunting herself”.

If so (I don’t believe them), their job was to protect a patient from her own folly. Instead they chose, in modern cant, to blame the victim.

Sexual harassment is only a small part of the problem. Many people, both men and women, feel their modesty is violated by such closeness to random members of the opposite sex, even when they are not threatened.

Patients lie naked, half washed and forgotten, their sick and ageing flesh exposed to everyone, while nurses rush elsewhere. It is commonplace to have to walk to filthy mixed lavatories with gowns wide open at the back. At a time of sickness and anxiety many people are profoundly embarrassed to be surrounded by a clutter of bed pans, colostomy bags, nakedness, cries of pain and sweat, blood and tears — their own and other people’s.

All this is much worse, for many, when they are surrounded by members of the opposite sex; shame and anxiety are not the best bedfellows of hope and healing.

Much has been written about the rape of modesty and the death of shame. However, it is still true in this weary country that most men and women prefer to perform private bodily functions alone if possible, and among their own sex only, if not. That’s why we have separate public lavatories and separate changing rooms in shops and clubs and pubs. That’s why people put up towels on the beach. That’s why women give birth in female wards, not in mixed wards or not — I hope — so far.

Admittedly there are some who believe that mixed wards are not a problem, but our prime minister is not one. “Is it really beyond the collective wits of the government and health administrators to deal with the problem?” he demanded in 1996, flying high on vectors of dizzying youthful indignation as leader of the opposition. “It’s not just a question of money,” he went on. “It’s a question of political will.” Well, he said it and he promised to end mixed-sex wards by 2002

What we have come to expect of new Labour promises, following failure, changing the goalposts, more failure and exposure, is denial. Sure enough Patricia Hewitt, the health secretary, was sent onto the Today programme in denial mode last week.

Although the Healthcare Commission watchdog found that on average 22% of patients have to stay in mixed-sex wards, rising to 60% in some hospitals, Hewitt’s officials at the Department of Health say the government has achieved its target of abolishing mixed-sex wards, with 99% of trusts providing single-sex accommodation.

It is not difficult to spot the problem with that claim. It is not the same as saying 99% of patients get single-sex accommodation; it may be “provided” for very few. There has been the usual goalpost shifting: hospitals can claim they are providing single-sex accommodation by putting screens between beds in mixed-sex wards. Brilliant.

Hewitt admits there was a problem of perception; she even admitted that there was a “clear gap” between patients’ experiences and figures provided by hospital trusts to the Department of Health. One does tend to have a problem of perception, I find, if one is being misled.

My feeling is that mixed-sex wards are not the worst of NHS hospitals’ problems, although they demonstrate them. They demonstrate the incompetence and deviousness of hospital management in general, and they also show something worse. In all the stories I’ve come across what stands out is the ignorance, incompetence, laziness and heartlessness of all too many nurses, who are allowed to neglect and insult their patients without supervision and without sanction — in single-sex wards just as much as mixed.

Blair did not just promise to abolish mixed-sex wards, he also promised to save the entire NHS. He believes in divine judgment; I wonder how he will answer.

Sunday, November 26, 2006

Another Psychiatric Disease Under Fire

As seen in NewsDay A situation where criminal activity became a mental disease, and then became a profit motive?

Nowhere is the controversy surrounding Munchausen syndrome by proxy fiercer than in England, the country where the diagnosis was first identified.

The two doctors most closely associated with the syndrome - Roy Meadow, who wrote the article introducing it in 1977, and David Southall, who used covert video surveillance to record parents hurting their children in hospitals - in the last few years found themselves fighting for their medical licenses and reputations. In 2004, the British government ordered the review of more than 250 cases of parents convicted of killing their children on the basis of testimony from Meadow, Southall and other experts dating back a decade.

"I think in England the accusation has been thoroughly trashed by the media and also by professionals who realize now that this really got out of hand, and particularly that it was very easy to blame mothers when that wasn't what was happening," said Eric Mart, a psychologist and Munchausen expert from New Hampshire who has testified on behalf of accused parents in dozens of cases. The acquittals "have really stifled accusations of Munchausen syndrome by proxy."

In the decades following Meadow's 1977 article, which described a mother who injected her own blood into her child's urine and another who poisoned her child with salt, the number of Munchausen accusations in the United Kingdom and beyond began rising. But criticism of Meadow and the diagnosis mounted following two high-profile acquittals in cases that had relied on his expert testimony.

In January 2003, Sally Clark, a lawyer, won an appeal of her conviction for killing two of her children after it was disclosed that at least one boy had a serious bacterial infection. Her conviction four years earlier had been based largely on Meadow's testimony that there is only a one in 73 million chance of two SIDS deaths in a single family, a statistic that has since been discredited.

In December 2003, Angela Cannings, who was convicted of killing two of her children also largely on the basis of Meadow's testimony that she was a Munchausen mother, was freed on appeal when a judge learned there was a history of SIDS in her family. Following these acquittals, Meadow lost his medical license but won it back on appeal.

Southall, a British pediatrician, launched a study using video surveillance to try to identify Munchausen parents in 1986. Over the next eight years, the controversial videotapes, some of which show mothers appearing to suffocate their children or removing their IV tubes, led to Munchausen accusations against 23 parents and 33 total abuse prosecutions. He was investigated by England's General Medical Council, which stripped him of his right to work in child protection but allowed him to keep his medical license, after testifying against the husband of Sally Clark.

The acquittals of Cannings and Clark, coupled with the rising influence of mothers publicly fighting Munchausen accusations, led many in England to begin calling Munchausen the "discredited" diagnosis, and the number of cases there has dropped dramatically. Some say, however, that the pendulum has swung too far - pointing out, for instance, that four of those captured on video by Southall pleaded guilty - and is creating a climate in which practitioners are afraid to make any child abuse accusations at all.

"The strongest piece of scientific data are those 39 cases published by David Southall. You just have to read those cases to know that if this is out there, it's something you want to protect children from," said Herbert Schreier, a child psychiatrist who co-wrote the book "Hurting for Love." "And the reality is that now nobody wants to go near these cases."

Saturday, November 25, 2006

Psychiatrists fight against mental health services reform

It seems that psychiatrists in Isreal are fighting tooth and nail against Mental Health Reform. As seen in this report, it seems like they are protesting the end of a profitable business as usual system. While we present the report, we remain ever so skeptical of their arguments. It's always about the money, y'know.

The long-awaited reform of mental health services that will transfer responsibility for them from the Health Ministry to the four health funds will in fact "trigger their collapse," according to the Israel Medical Association (IMA) and the Israel Psychiatric Society. The two groups issued an emergency call on Wednesday to prevent its implementation on January 1.

Representatives of the two organizations, joined by heads of the Israel Society for Pediatric and Adolescent Psychiatry, the Government Doctors Union, the Psychologists Association and Social Workers Union, called for an urgent revamping of the reform so it would not harm patients and professionals in the mental health field.

The agreement reached in recent months by the Health Ministry and the Treasury for implementing the reform is a "serious perversion" of the planned reform, whose roots go back to recommendations of the 1989 State Judicial Commission on the Health System, they said.

"It will cause many patients to be thrown into the street without any treatment for them," they said.

Instead, they called for "a real reform, which is vital and necessary, in cooperation with the organizations of professionals who treat them."

When the National Health Insurance Law went into effect in January 1995, mental health services were supposed to be transferred gradually by the ministry to the health insurers, but the Treasury opposed it on the grounds that it would cost a lot of money and it never happened.

The main arguments in favor of the reform were that treating mental illness like physical illness would eliminate much of the stigma of psychiatric and psychological problems and that the ministry had an inadequate budget for services.

The IMA, the psychiatric society and the other professional organizations favored the reform concept, even though it has already led to the elimination of 4,000 psychiatric hospital beds, with stress placed on treating patients with newer medications and psychiatric and psychological counselling in the community.

But the Treasury, "which never supported the reform, searched for ways to make it fail, and it is carrying out only a reform of reducing services," the medical representatives said.

According to an agreement signed in September by the Health and Finance Ministries, 50 community mental health clinics and stations owned and run by the Health Ministry will be closed.

In addition, said opponents to the reform, the Treasury was allocating only NIS 160 million extra for implementation instead of the 300 million that is the minimum needed for the health funds to set up and provide adequate services.

"What is the logic of closing facilities before new ones open in the community?" they asked. "Why close clinics that have proven themselves to be professional and beneficial?"

Dr. Jacob Polakiewitz, head of the ministry's mental health services, denied the claims and charges.

The ministry will transfer to the health funds the NIS 1.1 billion it has spent each year on mental health services, including NIS 760 million for hospitalization and NIS 430 million for community-based services, he said. In addition, the health funds will share an additional NIS 40 million a year over four years, for a total of NIS 160 million more.

"Government psychiatric hospitals will continue to function as today, but the health funds will purchase services from them to treat their members. The health funds cannot provide community services on their own today," said Polakiewitz, "so initially they will purchase services from the existing clinics. They will then either purchase clinics or hire some or all of the professionals for their clinics or independent professionals."

The ministry official said he understood the fear of cuts, but that the intention was to expand rather than shrink services. Patients who suffer from anxiety, depression or trauma from life experiences would continue to get treatment, but from the health funds rather than the ministry, he said.

Only two percent of the population now receives psychiatric treatment, said opponents of the reform, while the norm in the Western world is 4% - and those countries do not suffer the stresses of war and terror and the history of suffering in the Holocaust that Israelis do.

Increasingly, psychiatrists' time with patients has been limited. Under the new program, only people with diagnosed psychiatric disorders will receive help, while those who suffer from stress and trauma from life events and experiences will be ineligible.

The reform would not save money, the opponents argued, as without real therapy, patients would suffer breakdowns and have to be hospitalized again.

Children and adolescents suffering from mental problems, especially those in the periphery, would suffer the most from the reform, the mental health professionals charged. Rehabilitation of patients would be dealt a death blow, they continued, as hostels, protected living arrangements, clubs and sheltered workshops that employ them would be wiped out from lack of budget.

The reform, they maintained, has "turned into the Treasury's reform, without any support from mental health professionals who dealt with the issues for 11 years. There is not one single factor that supports it. All think it will be a disaster."

Earlier this week, at a Jerusalem public health conference, Health Minister Ya'acov Ben-Yizri said he was proud that responsibility for mental health services would finally be moved to the insurers.

"One can't solve every problem in advance, but we will go ahead even if it steps on some toes and hurts the prestige and the livings of some groups," he said. "There will be special committees to monitor implementation and deal with problems. If we wait, it will never get done."

They're getting away with murder - British mental health services are in turmoil

An interesting opinion piece in the Times Online, regarding the sheer incompetence of psychiatry in Britian.

If you ever feel like overdosing on euphemisms, I advise doing time with the mental health lobby. This is something I have done on and off, out of journalistic interest. These people do heroic work with sufferers, and campaign to highlight their needs. But their determination to stamp out stigma can lead them to rewrite reality. Illness has become health. Patients have become clients. Savage attacks on other people have become “untoward incidents”. Now last week’s devastating inquiry into the death of 50-year-old Denis Finnegan, murdered while cycling through Richmond Park by a paranoid schizophrenic, John Barrett, is being twisted by powerful groups who put patient “rights” above public protection.

A respected consultant psychiatrist neatly summed up his profession’s hostility to inquiries. “Being retrospective,” he said, “they foster a simplistic notion of the preventability of homicides”. Really? What last week’s inquiry showed was that Finnegan’s death was wholly preventable, caused by gross incompetence and arrogance — from the tribunal that discharged Barrett in the absence of his doctor, to the psychiatrist who gave him an hour's leave from hospital, to the nurses who failed to warn the right people that he had not returned.

Once again — and I am a bit of a connoisseur of these inquiries — we read of “cumulative failure”. An innocent person is hacked to death by someone with clear warning signs: in this case, violent voices in his head. But the psychiatrists always know better.

The Barrett inquiry is crystal clear: the South West London and St George’s Mental Health Trust, which “cared” for him, is incapable of putting its own house in order. Yet the trust blithely issued a confident statement last week about improvements already made. The whole reaction has been surreal. On Friday the Royal College of Psychiatrists insisted that “all the professionals involved in this inquiry [must] be supported” and announced that it is planning — a seminar. Shouldn’t someone be sacked? No. I can find only one example of a psychiatrist resigning after a murder inquiry, and that was in 1997.

The Mental Health Alliance, a group of 80 charities, is concerned only to emphasise that Finnegan’s death was “extremely rare”. This is a familiar refrain from those who fear the public will shun schizophrenics. But it borders on falsehood. When I called the Department of Health this week, I discovered that between 55 and 63 people are killed every year by people who have recently been in contact with mental health services. At about 10 per cent of the total murder count, dare I say this is quite a lot?

The charity SANE believes that at least one in three of those murders is preventable. Its analysis of 69 such inquiries finds that in half the cases, professionals had ignored warnings from family and friends. Some psychiatric patients refuse treatment. What is less well known is how many others are denied it, even when they or their relatives are crying out for it.

The Barrett inquiry vividly describes the culture that seems to be endemic among the lunatics running our asylums. “Too much confidence,” it finds, “was placed in clinical judgments unsupported by evidence and rigorous analysis.” There was a preference for “engaging” with patients, over “intervening”. There is an understandable reluctance to act in loco parentis for adults who may at times be perfectly capable.

But the jargon of “empowerment” creates nonsenses. It means a manic depressive choosing not to “engage” with social services, which then walk away. It means a schizophrenic choosing whether or not to take medication, even if he has a violent history. It means setting Barrett free to buy a packet of knives and take a taxi to Richmond Park. In most cases, treating people who have lost their reason as though they were rational beings leads to misery and neglect. In a few cases it leads to death.

Last Friday, the Government launched proposals for community treatment orders (CTOs). These would compel formerly detained patients who pose a risk to the public to take their medication or return to hospital for treatment. A vast lobby is massing against this. The Mental Health Alliance is comparing CTOs to ASBOs, and muttering about human rights. But they will only apply to a small number of potentially dangerous individuals. They could provide greater stability for people who are on the misery-go-round between prisons, hospitals and the “community”. The lobby makes much of the Barrett inquiry’s finding that the problem was not lack of legislation. But the inquiry does support CTOs.

Compulsion is tricky territory. But that does not justify selective deafness about the findings of such an important investigation. The light that such processes shine may explain why there is now a concerted effort under way to circumvent them. Finnegan’s brother was originally offered an internal review by the mental health trust, and told he would have to sign a confidentiality contract to read it. It was only with the support of the Zito Trust, one of the sanest charities, and John Reid, then the Health Secretary, that he got an independent inquiry.

Others have not been so lucky. Haringey Primary Care Trust has just completed an internal review into the case of Ismail Dogan, who stabbed six people in North London in 2004, killing one. His mother had appealed for help after he had stopped taking his medication, but got none. Will Haringey publish?

We cannot get away from what happened to Denis Finnegan by giving it another name. It was murder, and someone needs to take responsibility for it.

Documents show violations Cape Fear Valley Medical Center

As seen in this report from the Fayetteville Observer

A 13-year-old girl with a history of depression and suicidal thoughts went to Cape Fear Valley Medical Center in January 2005 for treatment.

Within five minutes the emergency room psychiatrist — who had seen her before — called her a criminal and told her to leave and not return. But she did.

On the way back to her Fayetteville group home, and upset about the hospital visit, she suffered a skull fracture and internal injuries when she jumped from a car traveling 40 mph. This time she was treated in intensive care.

The incident was categorized by state investigators as one of the most severe violations that can occur in a hospital, and it became part of a series of violations that have made Cape Fear Valley perhaps the most heavily cited hospital in the state in the past three years.

The state conducts the investigations for compliance with federal Medicare and Medicaid standards.

Joyce Korzen, Cape Fear Valley’s chief operating officer, said violations found by the state always have been corrected, and the hospital has never lost eligibility to receive federal funding or been penalized with fines.

Cape Fear Valley, a private, nonprofit corporation, has previously disclosed that space and staff limitations in its emergency department have caused patients to wait several hours for treatment. But documents obtained from the N.C. Health and Human Services Division of Facility Services provide details on other major violations that have been previously unreported.

From January 2005 to June 2006, the state determined three instances when Cape Fear Valley was out of compliance with requirements to receive Medicare and Medicaid funding because of six major violations. Each time, the federal Centers for Medicare and Medicaid Services, known as CMS, issued Cape Fear Valley a termination date for losing funding.

Losing such funding would cost the hospital about two-thirds of its $1.2 billion annual operating budget. The 394-bed acute care facility is Fayetteville’s largest.

The psychiatrist who denied treatment to the 13-year-old girl resigned five weeks later, but state inspectors have found similar violations since then. Mistreatment of another suicidal adolescent was among more federal violations that were resolved just two months ago.

Many of the violations were found in the treatment of psychiatric patients whose emergency room visits have increased due to cuts in state mental health services that have affected many hospitals. But the number of violations at Cape Fear Valley, along with other violations that did not involve behavioral care, is believed to be among the highest in the state.

“I’m not aware of a system or hospital in the last three years that’s had that number,” said Cecilia Boone, a Facility Services hospital surveyor.

Boone leads the state’s investigations on complaints about federal emergency treatment standards. She was involved in all three of the recent inspections at Cape Fear Valley and said the hospital was cited with another major violation in 2004.

The state is not required to keep track of how often hospitals are cited, and CMS did not have immediate information to compare the number of Cape Fear Red Lake Indian Reservation Valley’s violations with other North Carolina hospitals.
More at the Link

Friday, November 24, 2006

Charges have been dropped against the naked prosecutor

On October 12th we had reported on an apparent new side effect of psych drugs, namely Nude Behavior. A public prosecutor had been caught running around naked after hours at the office. His defense blamed the episode on a side effect of the psych drugs his was taking.

In this update, we can say that charges have been dropped against the naked prosecutor. Apparently there was a problem in the briefs.

Charges against a former city prosecutor accused of public indecency were dropped Tuesday because they were improperly filed, his lawyer said.

Authorities had charged Hamilton prosecutor Scott Blauvelt after a guard monitoring a security camera saw a naked man in the county office building the night of Oct. 5.

The previous night, security video had captured Blauvelt, who has since been fired, naked in another area of the building, where city offices are located, authorities said.

Blauvelt’s attorney, Mike Gmoser, said that charges were dropped because Blauvelt had been charged under a law no longer in effect, and that prosecutors have not decided whether to refile charges.

Blauvelt, 35, was suffering from a bad reaction to medication prescribed for depression and to control seizures related to a 2005 traffic accident, Gmoser said.

The Madness of Massive Psych Drugs Combinations for Children

As seen here, a sad tale on what we are doing to our kids. It looks like that the more drugs the kids are on, the more it is a case of getting all of the side effects without any of the supposed benefits.

Their rooms are a mess, their trophies line the walls, and both have profiles on Stephen and Jacob Meszaros seem like typical teenagers until their mother offers a glimpse into the family’s medicine cabinet.

Bottles of psychiatric medications fill the shelves. Stephen, 15, takes the antidepressants Zoloft and Desyrel for depression, the anticonvulsant Lamictal to moderate his moods and the stimulant Focalin XR to improve concentration. Jacob, 14, takes Focalin XR for concentration, the anticonvulsant Depakote to moderate his moods, the antipsychotic Risperdal to reduce anger and the antihypertensive Catapres to induce sleep.

Over the last three years, each boy has been prescribed 28 different psychiatric drugs.

“Sometimes, when you look at all the drugs they’ve taken, you wonder, ‘Wow, did I really do this to my kids?’ ” said their mother, Tricia Kehoe of Sharpsville, Pa. “But I’ve seen them without the meds, and there’s a major difference.”


A growing number of children and teenagers in the United States are taking not just a single drug for discrete psychiatric difficulties but combinations of powerful and even life-threatening medications to treat a dizzying array of problems.

Last year in the United States, about 1.6 million children and teenagers — 280,000 of them under age 10 — were given at least two psychiatric drugs in combination, according to an analysis performed by Medco Health Solutions at the request of The New York Times. More than 500,000 were prescribed at least three psychiatric drugs. More than 160,000 got at least four medications together, the analysis found.

Many psychiatrists and parents believe that such drug combinations, often referred to as drug cocktails, help. But there is virtually no scientific evidence to justify this multiplication of pills, researchers say. A few studies have shown that a combination of two drugs can be helpful in adult patients, but the evidence in children is scant. And there is no evidence at all — “zero,” “zip,” “nil,” experts said — that combining three or more drugs is appropriate or even effective in children or adults.

“There are not any good scientific data to support the widespread use of these medicines in children, particularly in young children where the scientific data are even more scarce,” said Dr. Thomas R. Insel, director of the National Institute of Mental Health.

Psychiatrists who prescribe drug combinations say that the ability to mix and match medications improves their chances of being able to help children who are seriously, even desperately, ill.


The controversy leaves parents in a terrible bind. Desperate to help, many agonize over whether to medicate their children.

Mothers and fathers sometimes disagree, with the dispute straining or even ending marriages. Since some psychiatric drugs can cause worrisome physical effects, parents say that they must on occasion make a terrifying choice between their child’s physical health and his mental health.

The parents interviewed for this article told their stories, they said, in hopes of gaining greater acceptance for their children and themselves. Nearly all recalled being in a store when their child threw a tantrum and feeling that onlookers branded them as bad parents. They also said they hoped to help others negotiate what many said were unequal and often fraught relationships with psychiatrists.

“We struggled so much, made so many mistakes and felt so stigmatized, I hope our story can make it easier for others,” said Jacquie Erickson of Anchorage. Her daughter, Kaitlyn Johnston, 10, has taken psychiatric drugs since she turned 5 for diagnoses that include bipolar disorder.

On Shaky Ground

Stimulants like Ritalin are by far the most commonly prescribed psychiatric medicines in children. But doctors routinely pair stimulants with antidepressants, antipsychotics and anticonvulsants, even though some of these medications can cause serious side effects, have few proven pediatric psychiatric benefits and lack clear evidence about how they interact or influence mental and physical development.

Last year, the Food and Drug Administration required drug makers to warn on their labels that antidepressants can cause suicidal thoughts and behavior in some children. Anticonvulsant drugs carry warnings about liver and pancreas damage and fatal skin rashes. The side effects of antipsychotic medicines can include rapid weight gain, diabetes, irreversible tics and, in elderly patients with dementia, sudden death. When drugs are combined, these risks compound.

Ms. Kehoe, who receives government financial and child-care assistance because her children are considered mentally ill, said she knew that there were risks to the drug cocktails. Both her sons are short and underweight for their age — a common side effect of stimulants — and she fears that the drugs have affected their health and behavior in other ways.

“But I don’t think the insurance would pay for it if the F.D.A. didn’t decide that children should use it,” said Ms. Kehoe, who herself takes psychiatric medication.

In fact, the drug agency has specifically warned against the use of Lamictal, one of the drugs Stephen takes, in children who, like him, do not suffer from seizures because in 8 out of 1,000 children the drug causes life-threatening rashes.

Stephen and Jacob’s psychiatrist did not reply to telephone messages left with an office secretary on three different days. Ms. Kehoe said that she asked him to speak to this reporter but that he refused. The boys have had 11 psychiatrists over the last three years, according to prescription records, and many more before that, Ms. Kehoe said.

In interviews, Stephen and Jacob said they hated taking their drug cocktails.

“Everybody hates meds,” Jacob said.

Ms. Kehoe said her youngest son, Lucas Keck, was showing signs of attention deficit disorder and might soon need to start medication.

“I see the hyperness in him,” she said. “My pediatrician has said that he would venture to say that Lucas will be A.D.H.D.”

Stephen and Jacob were Lucas’s age — 6 — when they were given their first prescriptions.

The F.D.A. requires drug makers to prove that their drugs work safely before the agency will approve them for sale in the United States. But doctors can prescribe and combine approved medicines as they see fit. Such mixing is common in medicine but rarely studied by drug makers.

Psychiatrists started mixing psychiatric medications because the drugs were only moderately effective and often caused terrible side effects, said Dr. Steven E. Hyman, the provost of Harvard University and former director of the National Institute of Mental Health. “None of these drugs by themselves do an adequate job of controlling symptoms,” Dr. Hyman said.

If one drug failed, many psychiatrists assumed that two or more drugs used together might succeed. For decades, no one studied whether this was accurate. But in recent years, a trickle of studies have examined the question, with mixed results.


Even for single drugs, the effectiveness of some psychiatric medications in younger patients is questionable: most trials of antidepressants in depressed children, for instance, fail to show any beneficial effect. But hardly any studies have examined the safety or the effectiveness of medicine combinations in children. A 2003 review in The American Journal of Psychiatry found only six controlled trials of two-drug combinations. Four of the six failed to show any benefit; in a fifth, the improvement was offset by greater side effects.

“No one has been able to show that the benefits of these combinations outweigh the risks in children,” said Dr. Daniel J. Safer, an associate professor of psychiatry at Johns Hopkins University and an author of the 2003 review.

If the evidence for two-drug combinations is minimal, for three-drug combinations it is nonexistent, several top experts said.

“The data is zip,” Dr. Hyman said.

Many psychiatrists said that they turned to drug cocktails only in desperate circumstances. “If you’ve got a 15-year-old who is cutting up her arms, you’ve got a barn on fire and what are you supposed to do?” asked Dr. Alexander Lerman, a child and adolescent psychiatrist in New York, who said he rarely prescribed combinations.

Billy and Jackie Igafo-Te’o of Jackson, Mich., are among the desperate. In the last seven years, their 12-year-old son, Michael, “has been on just about everything you can put a child on,” Mrs. Igafo-Te’o said. He is now taking four medications: an antipsychotic, an anticonvulsant, an antidepressant and a sleep medicine.

Despite the medications, Michael’s behavior has grown increasingly disruptive. He has kicked and punched holes in almost every wall of the Igafo-Te’o home. He wrenched the sink off the wall in the upstairs bathroom and pulled two bedroom doors off their hinges, damaging the frames. The family no longer fixes the damage.

During a recent visit, Michael and Mr. Igafo-Te’o were sitting on the living-room floor. Michael wanted the phone. His father held it out of reach to prevent Michael from playing with it. Michael became increasingly desperate. He cried. He cursed.

“That’s it, you have a timeout,” Mr. Igafo-Te’o said.

“No, no, no,” Michael answered. “You pimp!”

He slapped his father in the face, hard. Mr. Igafo-Te’o hustled Michael into the kitchen and forced him to sit for 20 minutes.

“What’s the purpose of all this medication if I still have to do that?” Mr. Igafo-Te’o asked.

He said he wanted to end Michael’s drug therapy. Among other side effects, the drugs have made Michael obese, which has led to asthma.

Mrs. Igafo-Te’o quietly disagreed. “I’m afraid he wouldn’t be able to focus,” she said. “I’m afraid he would regress socially.”

“Regress socially? Look at him!” her husband responded, motioning to their son, crying uncontrollably on the kitchen floor.

“I have to believe in something,” his wife mumbled and walked out of the room.

Mr. Igafo-Te’o watched her go and then smiled apologetically.

“We always debate meds,” he said.


On Again, Off Again

Andrew Darr of Caldwell, Idaho, whose sons took medications, said that he was opposed to it from the start. “When you come home from work and instead of getting them clawing at your feet and yelling, ‘Daddy, Daddy,’ you get a lethargic grunt, it just kills you,” Mr. Darr said.

His wife, Leslie Darr, eventually agreed to stop the medicines, but only after a family tragedy.

The Darrs have four children, Nicholas, 16, Nathan, 15, Becky, 12, and Benjamin, 9. At 3, Nicholas suffered a mild brain injury when undiagnosed appendicitis led him to suffer weeks of high fever, Mrs. Darr said.

Mrs. Darr said that she was pressured by school officials to give Nicholas a stimulant at age 6. Nathan soon followed.

Three years later, the boys had a traumatic weekend away with relatives. A month after that, Mrs. Darr said, both were hospitalized for a week and given a diagnosis of bipolar disorder and prescriptions for antipsychotic, antidepressant and sleeping medicines.

Over the next three years, Nicholas’s weight ballooned to 140 pounds from 52. Nathan went to 115 pounds from 48. Neither boy got much taller, Mrs. Darr said. They did poorly in school.

Then Becky developed a brain tumor. A nurse practitioner gave Mrs. Darr free samples of an antipsychotic drug to help her cope. After starting it, she said, she could not sleep or think straight. She realized that she had been giving similar medicines to her sons for years and she decided to wean the boys off the pills.

Their behavior immediately worsened. At one point, Nicholas left the house during a blizzard wearing only boxer shorts, Mrs. Darr said. They found him in a tire swing saying, “Baaa.”

“There were several times that we almost gave up,” Mr. Darr said.

But after four months off medication, the boys’ behavior normalized, the Darrs said, and they were transferred out of special education and into regular classes. The Darrs recently allowed the boys to spend their first evening at a mall without supervision, and in July they gave both boys their first bicycles. “They’ve come a long way,” Mrs. Darr said.

In an interview, Nicholas said the drugs “were not cool.”

“You go to school and everybody thinks, ‘Look at that retard,’ ” he said.

This article has been edited for clarity and length

Wednesday, November 22, 2006

School Psychologist Accused of Faking Cases

As seen in this intro to the full report. The full news story is currently available to subscribers only, and will be available online in one month, during Christmas week. This news item seems to be taking palce in New York City.

A School Psychologist working with the Department of Education submitted 26 falsified Bilingual Psycho Educational Assessment Reports, collecting more than $10,000 on them, according to a report released by Special Commissioner of Investigation Richard J. Condon.

Tuesday, November 21, 2006

Oregon school psychologist arrested for ID theft

As seen here:

The Winston-Dillard School District has notified parents that an employee arrested on suspicion of identity theft and illegal possession of prescribed drugs has been placed on administrative leave and will not have access to confidential information while police are investigating.

The alleged crimes were not connected with the school. The district learned of the arrest after reading The News-Review's police log Nov. 13, Superintendent Duane Yecha said.

School psychologist Emily Lewis, 27, was arrested on suspicion of identity theft, a felony, and possession of illegal prescription drugs, which could be a misdemeanor or felony, depending on the drug, Roseburg Police Sgt. Aaron Dunbar said.

"Apparently she has an addiction to prescription pain killers," Dunbar said.

Lewis allegedly visited multiple urgent care centers, giving false names and dates of birth to get pain killers. A nurse at one of the centers recognized her and checked an earlier record, which had a photocopy of Lewis' driver's license, Dunbar said.

Police gave the school district a list of names Lewis allegedly used, and the investigation is continuing, Dunbar said.
And as reported here
A school psychologist has been placed on administrative leave following her arrest on suspicion of identity theft and possession of illegal prescription drugs, the Winston-Dillard School District said.

Emily Lewis, 27, also will not have access to confidential information during the police investigation, the district said in a notice to parents.

The district learned of the Nov. 13 arrest from the police log in the (Roseburg) News-Review, Superintendent Duane Yecha said.

Roseburg Police Sgt. Aaron Dunbar said Lewis visited multiple urgent care centers, giving false names and dates of birth to get pain killers.

A nurse at one of the centers recognized her and checked an earlier record, which had a photocopy of Lewis' driver's license, Dunbar said.

Police gave the school district a list of names Lewis allegedly used, and the investigation is continuing, Dunbar said.

Monday, November 20, 2006

NY State Considers Revisions to Aversion Therapy Regulations

As Seen here

Revised proposed regulations relating to Behavioral Interventions, including Aversive Interventions have been published in the State Register and are available for public comment. A two-page summary of the major revisions to the regulations that were adopted through emergency action in June 2006 is available to assist the public in its review of the revised proposed rules.

A full text of the revised proposed rule can be accessed at

Written comments on the proposed regulation must be received by December 15, 2006 and may be submitted to:

Rebecca H. Cort, Deputy Commissioner

VESID, New York State Education Department

Room 1606 One Commerce Plaza

Albany, New York 12234

Or by email to:

Attention: Comments: Behavioral Intervention Regulations

You can see the Summary here

Among other things, The regulations were revised to prohibit, without exception, the following aversive interventions:

* ice applications; hitting; slapping; pinching; deep muscle squeezes;
* use of an automated aversive conditioning device;
* the combined simultaneous use of physical or mechanical restraints and the application of an aversive intervention;
* withholding of sleep, shelter, bedding or bathroom facilities;
* denial or unreasonable delays in providing regular meals to the student that would result in a student not receiving adequate nutrition;
* placing a student unsupervised or unobserved in a room from which the student cannot exit without assistance;
* or other stimuli or actions similar to these interventions at the discretion of the Commissioner.
Meaning that these and other actions were previously permitted.

Please Take time to submit your comments.