Psychiatrist reprimanded, placed on probation for 'unprofessional and unethical conduct.'

Report from the Charleston Gazette, out of West Virginia

A South Charleston psychiatrist has been publicly reprimanded by the state Board of Medicine and placed on probation for three years after he allegedly carried on an inappropriate personal relationship with a patient through telephone conversations, e-mail and text messages.

Dr. Russ Voltin, who also works as co-medical director of the forensic evaluation unit at South Central Regional Jail, denied any sexual contact with the patient.

Voltin said the former patient concealed her identity from him, according to a consent order filed last week by the medical board.

The patient, whose name was not disclosed, alleged the online relationship with Voltin lasted from 2004 to 2007. The Board of Medicine started investigating the complaint in March 2007.

The board concluded that Voltin took part in "unprofessional and unethical conduct." Medical board members voted to suspend Voltin's license for three years, but stayed the decision, allowing Voltin to continue to practice while on probation.

Voltin also was directed to see a board-approved psychotherapist who must submit reports on Voltin's mental health every four months.

In addition, the medical board ordered Voltin to attend medical ethics classes. The board vowed to revoke Voltin's license if he takes part in inappropriate contact with patients during the next three years.

Voltin, who became a state-licensed psychiatrist in 1989, works at PsyCare Inc. in South Charleston.

He serves as regional coordinator for forensic psychiatry and assistant professor at the West Virginia University School of Medicine.

Voltin, 45, also has been a guest lecturer at WVU's law school. He was director of Thomas Memorial Hospital's psychiatric unit from 1994 to 2001.

Voltin did not return phone messages left at his South Charleston office Wednesday.

Psychiatrist reprimanded unprofessional and unethical conduct

Report from the Charleston Gazette, out of West Virginia

A South Charleston psychiatrist has been publicly reprimanded by the state Board of Medicine and placed on probation for three years after he allegedly carried on an inappropriate personal relationship with a patient through telephone conversations, e-mail and text messages.

Dr. Russ Voltin, who also works as co-medical director of the forensic evaluation unit at South Central Regional Jail, denied any sexual contact with the patient.

Voltin said the former patient concealed her identity from him, according to a consent order filed last week by the medical board.

The patient, whose name was not disclosed, alleged the online relationship with Voltin lasted from 2004 to 2007. The Board of Medicine started investigating the complaint in March 2007.

The board concluded that Voltin took part in "unprofessional and unethical conduct." Medical board members voted to suspend Voltin's license for three years, but stayed the decision, allowing Voltin to continue to practice while on probation.

Voltin also was directed to see a board-approved psychotherapist who must submit reports on Voltin's mental health every four months.

In addition, the medical board ordered Voltin to attend medical ethics classes. The board vowed to revoke Voltin's license if he takes part in inappropriate contact with patients during the next three years.

Voltin, who became a state-licensed psychiatrist in 1989, works at PsyCare Inc. in South Charleston.

He serves as regional coordinator for forensic psychiatry and assistant professor at the West Virginia University School of Medicine.

Voltin, 45, also has been a guest lecturer at WVU's law school. He was director of Thomas Memorial Hospital's psychiatric unit from 1994 to 2001.

Voltin did not return phone messages left at his South Charleston office Wednesday.

Drug Companies – The New Sin Stocks

A column in the American Chronicle by John Carey

It is part of the American dream to put a dollar into a company stock today, and get lots of dollars back when you sell. The only modifier to this dream by some is an aversion towards "sin" stocks – avoiding companies that make alcohol, cigarettes, pornography, guns or provide gambling.

But when I suggest that you pitch drug-companies into this same sin-bucket you probably think I´m joking. But I´ll let you in on my reasoning, which includes numerous lawsuits against the companies, lying by the company executives to market their drugs under false pretenses for profit´s sake, and drugs pushed on the public which knowingly harm more people with the side-effects than they ever help.

Side Effects

All drugs have side-effects! Taken for a short time to cure something worse, it is a beneficial exchange. But drug companies can´t make the huge profit for an antibiotic you take for two weeks as they can for a "mental-health" pill you take every day for the rest of your life!

With the first group of antipsychotics marketed, drug companies freed many people from the state hospitals. But one debilitating side-effect of these drugs (like Thorazine, Haldol and Prolixin) was that they caused involuntary, repetitive, and purposeless movements. In the 1990s, newer drugs called atypical drugs (like Clozaril, Zyprexa, Seroquel, Geodon and Risperdal) largely replaced the older meds and were marketed (at eight to twenty times the cost of the prior drugs) as causing fewer involuntary movements, but they have their own side-effects such as weight gain, diabetes and early death.

Tens of thousands of people sued Eli Lilly and AstraZeneca, saying that their drugs, Zyprexa and Seroquel, gave them diabetes and elevated blood sugar levels. Eli Lilly reports having paid $1.2 billion to settle over 30,000 lawsuits.

In 2008, Alaska sued Eli Lilly for the medical costs of Medicaid patients who developed diabetes while taking Zyprexa. One of Eli Lilly´s top executives sent an email encouraging Lilly to promote Zyprexa for a use not approved by federal drug regulators (known as "off label") and while doctors can prescribe a drug "off label", it is against federal law for a drug company to encourage this practice. Alaska settled with Lilly for $15 million and now other states are going after this legalized drug pusher. (Global sales of Zyprexa approached $4.8 BILLION in 2007.) Lilly also faces 1,200 cases as well as a federal probe over its marketing tactics.

Janssen's Risperdal got FDA approval to expand the use of the drug to address adolescent schizophrenia, the irritability of autism in kids and for bipolar disorder. In 2006, it was the most heavily prescribed psychiatric drug in New York´s Medicaid kids program, given to 17,393 children. It is also blamed in lawsuits nationwide for side-effects including diabetes caused by weight gain, Parkinson's-like movement disorders and gynecomastia, in which males grow breasts which have to be surgically removed.

The pharmaceutical companies have made astronomical profits since promoting the atypicals to treat mental disorders. Since the drug companies couldn´t claim that the atypicals were better than the old drugs, they paid doctors to say so. This brought about a widespread false belief that the newer medications were safer and worth the additional billions of dollars in taxpayer money to make these the states´ preferred drugs of choice. Since then, the life expectancy of people treated in community mental health centers has plunged to a point twenty-five years LESS than the average due to a higher incidence of cardiovascular disease as a side-effect of these drugs. (For comparison sake, being homeless cuts ten years off your life expectancy.) Chuck Areford said in a 2008 article titled "Antipsychotic Drugs are Doing Harm" that this "… must be ranked as one of the worst public health disasters in U.S. history."

Drugs Marketed Under False Pretenses

If you are the CEO of a company, a large part of your multi-million dollar compensation is tied to how well the stock does during your tenure. This has led the companies to promote their drugs much like the rest of Madison Avenue promotes cars or the latest perfume. However, while the brand of car you drive doesn´t adversely affect your health, which psych drug you take to hide your problems does.

The entire basis for the use of psychotropic drugs is a THEORY, not a fact! The media presents it as a fact that depression is caused by a chemical imbalance. However, even the psychiatric bible clearly states that the cause of depression and anxiety is unknown. Jeffrey Lacasse, a doctoral student co-authoring a study on this is quoted as saying, "… there are few scientists who will rise to its defense, and some prominent psychiatrists publicly acknowledge that the serotonin hypothesis is more metaphor than fact."

In 2006 4-year-old Rebecca Riley died of an overdose of psychiatric drugs that had never been approved or tested for children. She had been taking drugs for ADD and bipolar since she was two years old and died with four prescription drugs in her system. Her heart and lungs were damaged due to prolonged abuse of the prescription drugs.

Cheyenne Delp, a five year old, died in 2004 while on five prescription medications. One of the anti-depressants required that she undergo an EKG to determine if her heart was healthy enough for her to take it. The child psychiatrist, Dr. Saran Mudumbi, testified that Cheyenne was out of control and that she suffered from paranoia, depression and anxiety.

One of the main psychiatrists pushing treatment of children with psychatric drugs is Dr. Biederman who has financial ties with fifteen drug companies and serves as a paid speaker or adviser to half of them, including Eli Lilly & Co. (Zyprexa) and Janssen Pharmaceuticals (Risperdal).

A drug is approved by the FDA for narrow uses, but gets tried off-label on hard-to-treat conditions and the drug company´s sales force stokes up this usage until the research catches up years later that shows the initial enthusiasm was unfounded. With the limited schizophrenic and bipolar market for the atypicals, the drug companies marketed them as safer than their predecessors They came to be tried beyond the approved uses for nursing-home residents, prisoners, and children younger than six years old. Total U.S. sales for this class of drugs reached $13 billion in 2007, doubling the sales just five years earlier.

Research by three universities says long-term use of anti-psychotics offers "no long-term benefit for most patients." And while anti-psychotic medication is not licensed to treat dementia it is being given to 100,000 elderly patients in England to keep them manageable! Studies show that these drugs increase the risk of strokes and other harmful side effects. One study showed that after 3½ years, 60% of the Alzheimer´s patients given a placebo were still alive while only 28% of the group given the anti-psychotic medication were.

While an estimated 30-60% of U.S. nursing home patients are placed on antipsychotics, at the Bronx´s Providence Rest nursing home, the staff give massages to the patients. Utilizing this therapy, the nursing home has cut its use of antipsychotics to 2-3%, the lowest rate of any nursing home in New York!

The drug companies funded the committees which set up the state plans for defining which drugs to use for which treatments. Drug company profits then soared because the atypicals were listed as the first three choices over the older generic drugs. The states´ medical costs for patient care also soared! Now that the links to the drug company funding and the terrible side-effects have become known, nine states have sued Eli Lilly, four sued Janssen, and two sued AstraZeneca. Dozens of more states have teamed in a joint investigation, seeking billions of dollars in restitution for money they say they overpaid for atypicals through Medicaid.

In Minnesota alone, since 2002, drug companies have given $88 million in gifts, grants and fees to Minnesota doctors and caregivers. Several states, including Pennsylvania, are suing some drug makers for promoting their drugs beyond approved uses and commissioning "ghost-written" articles to increase sales

Drug companies fund and support front groups like NAMI and CHADD and programs such as TeenScreen, in order to create a demand for their products covertly. These groups may not promote drugs directly but rather they promote disorders, legitimizing mental illnesses that have never been validated as true medical diseases. Drug companies cannot make these claims directly but accomplish the same goal through these other groups and programs. TeenScreen, an invention of psychiatrist (with drug company connections) David Shaffer, is a screening program asking children as young as 9-years-old questions like, "Have you often felt very nervous when you´ve had to do things in front of people?" and "Are you Hispanic or Latino?" Based on their answers, TeenScreen refers them to mental health "professionals", who inevitably decide that these children have symptoms defined as "mental disorders", writing prescriptions for antidepressants and other psychotropic drugs for children with no objective medical testing. TeenScreen´s staff and advisory board are loaded with ties to Big Pharma.

(See: http://www.teenscreentruth.com/teenscreen_advisory_board.htm).

TeenScreen´s Director, Laurie Flynn was formerly at the helm of NAMI, which received over 11 million dollars in drug company funding from ´96 to ´99: Janssen ($2.08 million), Novartis ($1.87 million), Pfizer ($1.3 million), Abbott Laboratories ($1.24 million), Wyeth-Ayerst Pharmaceuticals ($658,000), Bristol-Myers Squibb ($613,505) and Eli Lilly $2.87 million.

In 2008 researchers using the Freedom of Information Act, dug out information on Prozac that shows it is no more effective than a placebo! The study included clinical trials that Eli Lilly chose not to publish when they studied the drug. The data showed that patients had improved - but those on the placebo improved just as much! (The only exception was in the most severely depressed patients.) 40 million people take this drug, earning tens of billions of dollars for Eli Lilly.

Is it the same sin to give capital to Playboy as it is to molest a woman? That is a question that only you can decide (with perhaps help from your pastor), but it doesn´t take much of a leap to imagine someone viewing porn and then going out and committing rape. You aren´t on the corner selling crack but you are just as guilty if you gave the crack dealer $10,000 to finance his supply.

Who knows what potentials for bad hearts, mis-wired brains and early deaths these drug companies have caused our society in their profit-search for a daily-pill-solution to what ails us? If putting money ahead of people´s lives and preying on those needing real help doesn´t make you a sin company, I don´t know what does.

So whether you now agree that pharmaceutical company stocks belong in the sin-stock category, or you simply believe that there are just too many liabilities for these companies to be good investments, either reason is enough to remove them from your portfolio forever.

Neither the author of this article nor his family will profit financially in any manner from drug stocks losing value

Restraint of foster kids questioned

A report from the Miami Herald

Last month, a 16-year-old Broward County girl was brought into Circuit Judge John A. Frusciante's courtroom for a hearing. She was handcuffed, her legs shackled with cloth restraints, with two armed deputies leading her by the arm.

Her offense? She's never been charged with one. A mentally ill foster child who was neglected by her mother and wound up in a psychiatric center, the teen was being restrained to keep her from running away, her attorney said.

The girl, who is not being identified to protect her privacy, is among scores of foster children in locked psychiatric centers in Florida recovering from abuse and neglect.

Now, the practice of restraining mentally ill foster children in court is prompting questions in both Broward and Miami-Dade counties.

In Fort Lauderdale, Walter Honaman, the 16-year-old's lawyer and an advocate for foster kids, is working with Frusciante and court officials to develop a voluntary policy to discourage deputies from handcuffing mentally ill foster kids who come to court.

And in Miami, a nurse practitioner who worked briefly as a director of patient care at Jackson Memorial Hospital's mental health center filed complaints with state regulators seeking to end the practice of restraining children who leave JMH's residential treatment center, or RTC.

''We bring these kids into the courtroom in handcuffs with armed deputies,'' said Honaman, who works for Legal Aid Service of Broward County. 'That's nuts. We don't maintain these kids' dignity, and we send the message that they are being punished. They are being treated like criminals. These are kids that need serious help.''

Administrators at Jackson have defended the use of ''walking restraints'' when children from their treatment center leave the facility, arguing many kids run away, which can endanger them.

The treatment center ''uses walking restraints for safety and prevention of elopement when clients are sent to an urgent medical appointment or court hearings that they can't miss early in their admission,'' Helga Mayrgundter, a program director for one of JMH's children's psychiatric units, wrote in an April e-mail.

Lorraine N. Nelson, a JMH spokeswoman, said the children's psychiatric unit uses walking restraints on less than 1 percent of its patients when they are being transported outside the facility, and follows all regulatory agency guidelines.

''The fabric restraints are only used when a patient is determined to be a flight risk and are removed immediately after a patient has returned safely to the facility,'' Nelson said. ``A board-certified psychiatrist with extensive experience in childhood trauma and behavioral management must write an order for the use of restraints.''

Jackson's use of foot restraints came under scrutiny beginning in April, when a new nurse administrator questioned the practice. The nurse, Lisa Burton, later filed complaints, including one to the Miami-Dade County Commission on Ethics and Public Trust.

The ethics commission ''conducted a thorough investigation of the allegations and ultimately dismissed the complaint,'' said JMH's Nelson. The commission findings, ''speak for themselves,'' she said.

In an April em-ail with other JMH administrators, risk manager Tish Batchelder wondered whether halting the restraints would lead to more escapes, thus ''putting patients in danger.'' But she also acknowledged: ``I hate the idea that we do it.''

Real leg shackles -- the metal kind -- routinely have been used for delinquent children who appear in court, though several public defender offices mounted a statewide campaign two years ago to end the practice. In most counties, shackling continues, said Miami-Dade Public Defender-elect Carlos Martinez, but The Florida Bar is lobbying for a new rule requiring hearings before restraints can be used.

Some judges say there is even less justification for restraining mentally ill foster kids who have not been accused of delinquency.

''It's a horrible stigma,'' said Miami-Dade Circuit Judge Cindy Lederman, who heads Miami's juvenile courts. ``These kids already have mental health problems. I would imagine this would exacerbate them. . . . These are not bad children, and they have not done anything wrong. They are just ill.''

Frusciante said he has been asking questions of treatment center and courthouse staff members who bring children to court in restraints. Among them: Do we have to do this?

''It was very disturbing,'' said Frusciante, who oversees child welfare cases in Broward. He said he wasn't disturbed enough to outright ban the practice at the courthouse, but he is working with Honaman to find ways to limit the use of restraints.

Most treatment centers elsewhere in the state have abandoned the use of restraints, according to internal JHM e-mails obtained by The Miami Herald.

''We do not use them here when we transport children,'' said Robyn Baskin, a children's program director at Personal Enrichment Through Mental Health Services in Pinellas County. If a child is too great a risk, Baskin said, travel will be postponed or additional staff is provided to ensure safety.

Psychiatrist in Murder Suicide

A report from Beirut, Lebanon

A psychiatrist committed suicide Wednesday morning after shooting dead a father and his two daughters.

Jack Hreiki, a 42-year-old psychiatrist, shot a 26-year-old lawyer, Chantal Ghanem; her sister Cheryl, a 29-year-old accountant; and their father Ghassan, a 58-year-old engineer; in the town of Batroumin in the northern province of Koura.

The victims were on their way to work in Tripoli when they were shot with a pump-action shotgun.

Hreiki, whose fellow townsmen described as a "psychiatrist in need of a psychological assistance," then went home and committed suicide.

A security source told The Daily Star that Hreiki knew his victims, as he was in love with Chantal, who had rejected him, for three years.

The source said Hreiki waited for the Ghanem family to leave for work, and when he blocked their path carrying a shotgun, the father stepped out from the car in an attempt to dissuade him from shooting. Ghassan was targeted first.

Hreiki then shot and killed the man's two daughters, who had witnessed the first shooting from the car.

Hreiki had repeatedly threatened Chantal, the sources said, and the Ghanem family had alerted the Internal Security Forces.

The homicide is the third this month [...]

A mental patient died after workers at a North Carolina hospital left him in a chair for 22 hours without feeding him or helping him use the bathroom,

From the MSNBC Report

A mental patient died after workers at a North Carolina hospital left him in a chair for 22 hours without feeding him or helping him use the bathroom, said federal officials who have threatened to cut off the facility's funding.

The state sent a team Tuesday to help Cherry Hospital in Goldsboro draft new procedures to ensure patients receive proper care.

An investigator's report released Monday found that 50-year-old Steven Sabock died in April after he at one point choked on medication and had been left sitting in a chair for close to a day at the facility about 50 miles southeast of Raleigh. Surveillance video showed hospital staff watching television and playing cards just a few feet away.

It was not clear from the report exactly how Sabock died. The report states that he was in a hospital bed and later found unresponsive. A phone call placed after business hours to the state Office of the Chief Medical Examiner rang unanswered Tuesday.

Federal officials have threatened to cut off funding because of Sabock's death and a report that a physician punched a patient after the teen bit the doctor.

Department of Health and Human Services spokesman Tom Lawrence said the state team also may investigate what, if any, disciplinary action should be taken following Sabock's death.

Lawrence said the Sabock incident is isolated but that officials are concerned.

"It's not the kind of thing that we in our wildest dreams would expect to happen in our hospitals - in our wildest nightmares, I guess," Lawrence said.

Sabock's father, Nicholas, declined comment when reached by telephone Tuesday evening. A man who answered the phone listed for Susan Sabock, Steven's wife, hung up without commenting.

The investigation released Monday said Sabock died in April after Cherry Hospital nurses left him unattended in a chair and did not feed him or help him to the bathroom.

The report said Sabock sat, unattended, in the room for four work shifts. The report also found that Sabock, formerly of Roanoke Rapids, ate nothing the day he died and had little food in the three days preceding his death. The 47-page report also said workers were supposed to be closely monitoring Sabock's condition and may have forged documents that said they had.

The state has until Aug. 23 to file a report with the Centers for Medicaid & Medicare Services detailing what changes officials are making, Lawrence said.

If the center rejects the report, federal funds will be cut off beginning Sept. 1, Lawrence said.

[...]

Jerusalem man says affair with psychiatrist damaged his mental health

A report out of Jerusalem

A 55-year-old man from Jerusalem intends to tell a Jerusalem court next month that a sexual relationship he had with his female psychiatrist in her private clinic damaged his mental health. The case is expected to set precedents concerning the psychiatrist-patient relationship.

The case, pertaining to 114 therapy sessions between October 2000 and November 2001, had been under a gag order since deliberations began in the Jerusalem District Court in January 2004. The psychiatrist, Tamar Kafri-Deutsch, denies ever sleeping with the man.

In March this year, Judge Zvi Zylbertal granted the complainant's request to make the details of the case public, except for the complainant's identity. "There is a distinct public interest in putting this issue on the agenda, to demonstrate the dangers of what could occur during psychological therapy," Zylbertal wrote in his ruling.

"The special relationship that is formed between patient and psychiatrist and the dependence that could grow from it - which could result in abuse - merit examination."

By making the case public, Zylbertal said he hoped to "increase awareness and prompt victims to come forward and complain to the authorities or seek compensation," as well as to "deter other therapists from crossing lines and boundaries, thereby sparing other patients future transgressions."

Zylbertal also chose to hear the complainant's case after becoming convinced that patient and psychiatrist indeed engaged in a romantic relationship - a fact that Kafri has consistently denied.

Although the court has yet to determine whether a sexual relationship between doctor and patient damaged the complainant's mental health, the court's ruling means that Kafri seriously violated the medical ethics code. The code states that "sexual and erotic contact between a therapist and a patient seeking psychological therapy is strictly forbidden and constitutes a grave ethical transgression and patient abuse, which could irrevocably damage the patient's mental health."

Israeli law had hitherto viewed sexual contact between psychiatrist and patient as a criminal offense carrying a sentence of up to seven years in prison. But the law has been made less stringent because of the case in question.

Kafri, according to the ruling, first met the complainant at a Health Ministry mental-health clinic in Jerusalem's Talpiot neighborhood, where the complainant's family doctor had referred him.

The psychiatrist then suggested that he come to her own clinics, one in Bnei Brak and the other in Jerusalem, for private treatment to prevent him from "falling between the cracks," as she put it. She repeatedly told the complainant not to mention this to other employees at the ministry's clinic, according to the ruling.

Kafri, also 55 years old, graduated in 1984 from Tel Aviv University as a medical doctor. She then specialized in psychiatry, serving at several public mental health facilities including Be'er Yaakov, Talbieh, Kfar Shaul and Hadassah University Hospital, Ein Karem. She also specialized in psychoanalysis. She described herself in court as an "accomplished and renowned psychiatrist privately treating many patients.

She added that she has stopped practicing psychiatry in recent years since she moved to the United States with her husband. Kafri cited this in requesting that the court squelch the story. "Those who were treated by Dr. Kafri in the past are entitled to know about this case," Zylbertal ruled.

Another issue in the indictment is payment that Kafri received from the complainant. He claimed that he paid the psychiatrist not only with money, but with gardening and minor construction work at her Jerusalem home.

Kafri explained that this was in the framework of "rehabilitative work." The Israel Psychiatric Association's ethics code from 1997 states that a psychiatrist can only receive monetary payment, which should be agreed on in advance, and must not receive anything else. The court calls the payment procedures "bizarre," adding that the complainant claims that this arrangement set the scene for a sexual affair.

The central piece of evidence in the case is a 70-minute telephone conversation, which was recorded, transcribed and submitted to the court in a 33-page document. In the document, Kafri replies to the complainant's observations about an "affair that was ignited" between them.

"I shouldn't have let it happen," Kafri said in the conversation. "We managed to viciously hurt one another - we were both very frivolous. We tried to ignore it, and then it hit us when we weren't expecting it. I had to put an end to it at some point because I saw what huge damage it was causing both of us."

Hey there's big money in Drug Advertising -- Want Some??

We have come across this splendid little satire in which you can write you own drug commercial or invent your own drug print ad.

All courtesy of the fine folks at Ad Freaks who describe it this way.

The new fun thing online, apparently, is creating one's own fake drugs. A few months back, I created Dave-agra ("Dave" plus "Viagra." Don't ask!) at GetYourDrugOn.com, a site created by Door No. 3 for Cedra, a real overnight medical firm. The resulting phony slick print ad was fairly amusing.

Now, Holton Sentivan + Gury's self-promo site raises the dosage (ha!) by letting users make their own Big Pharma live-action TV spots. "There's money in drug advertising," the site explains. Fair enough.

My drug, flogged in the video above, is called Daveoxyn. The guy in the faux spot doesn't really look like me, but he captures my inner malaise and fear of losing what's left of my hair. At the end of the ad, he's shown blissed out and drooling, which is always my goal on Saturday night. If this were a Tylenol spot, sales would skyrocket. It would also probably work for Pepsi.

California pays millions for contract psychologists - The equivalent to working 100 hours per week for 52 weeks at nearly $300 per hour

From a much longer article in the LA Times

Page two here. We note that the single page version of the story was re-written, and is substantially different from the version we have posted below.

A 2006 law intended to crack down on sex offenders has proved a bonanza for a small group of private psychologists and psychiatrists, 14 of whom billed California taxpayers last year for a half a million dollars or more each, a Times investigation found.

Among the 79 contractors hired by the state to evaluate sex offenders, the top earner was Robert Owen, a Central Coast psychologist who pulled in more than $1.5 million in 2007, according to state records reviewed by The Times.

That's equivalent to working 100 hours per week for 52 weeks at nearly $300 per hour -- top-scale in the private sector.

The No. 2 earner, psychologist Dawn Starr, billed the state $1.1 million in 2007, including $17,500 for a single day in April.

"It's been a boatload of money, to put it colloquially," psychologist Shoba Sreenivasan said during court testimony in November. Working only part time, she billed the state nearly $900,000 last year and at least $290,000 this year.

A civil servant doing the same work earns $101,000 to $110,000 annually.

Passed overwhelmingly by voter initiative in 2006, Jessica's Law mandated evaluations for thousands more sex offenders than in the past, to determine whether their conditions warrant hospitalization after criminal sentences have been served. All told, evaluators hired by the state earned more than $24 million in 2007.

It's unclear, however, what benefit the investment has yielded. There's been a nearly ninefold increase in evaluations and a threefold increase in recommendations for hospital commitment. But the actual number of commitments has remained essentially the same -- 41 in the 18 months before the law was passed, 42 in the 18 months afterward.

As the state confronts a budget shortfall of $15.2 billion, legislation to fund contractors to evaluate offenders through 2010 is expected to be voted on in the Assembly as soon as this week. Costs from Jessica's Law are expected to rise to several hundred million dollars annually over the next eight years, with further increases thereafter, according to projections by California's legislative analyst.

State officials defend their approach, saying they have moved aggressively to implement the voters' mandate.

"The public needs to appreciate how seriously we took the 70% vote for Jessica's Law, and public safety," said Stephen Mayberg, director of the state's Department of Mental Health, which manages the program. "Was it like a crisis? Yes. . . . Anybody who was willing to take on evaluations at any time and in any place could literally work around the clock."

Mayberg said the backlog of imminent parolees has diminished, so the cases now can be distributed more evenly among contractors. But fees will remain high and the overall costs about the same, even if million-dollar payments disappear.

He described the work of his department and its contractors thus far as "heroic."

Jessica's Law required evaluations for convicts nearing parole for a single sex offense -- even if committed as a juvenile -- in any of 35 categories. Before that law passed, at least two offenses were required in any of nine categories.

To induce contractors to work more and to attract new ones, the Department of Mental Health roughly doubled its compensation to $3,500 for an initial evaluation and $200 per hour for legal testimony and travel.

In 2005, state evaluators -- almost all contractors -- reported on 244 individuals. In 2007, the first full year after passage of Jessica's Law, they evaluated 2,201.

"They were shoving these things down our throats," said psychologist Thomas MacSpeiden, an evaluator who earned more than $400,000 last year. "They were just saying, 'take them, take them, take them!' "

[...]

Child psychiatrist pleads guilty to sexual assault of young relative

A report from Grand Rapids, Michigan

A child psychiatrist has pleaded guilty to two counts of sexual assault involving a young relative.

Carlos Alberto Marcano, 59, of Byron Township, will be sentenced Sept. 24 in Kent County Circuit Court on counts of first-degree and fourth-degree criminal sexual conduct.

Police earlier said he had confessed to sex abuse that happened between 2005 and 2007.

He was a psychiatrist with Pine Christian Mental Health and Community Mental Health for Central Michigan, but the incidents had no connection to his work.

Marcano entered the plea the day he was set for trial.

Psychiatrist had been previously investigated, and now faces more complaints

Report From the Hartford Courant

On Feb. 14, 2002, Attorney General Richard Blumenthal asked Connecticut health regulators to yank Dr. Peter Benet's license to practice medicine, calling the psychiatrist a "physician who sacrificed his patients for money and power."

But the state didn't take action. Benet continued to see patients. Now he is facing disciplinary action by the Department of Public Health, based on two unrelated complaints.

Those complaints, Blumenthal said, might have been prevented if the health department had listened to him six years ago when he recommended that Benet's medical license be suspended or revoked.

"Tragically and unfortunately, these latest complaints vindicate the serious recommendations we made years ago," Blumenthal said. "We issued a scathing report that left no doubt about this physician arbitrarily denying medically necessary care to patients."

A spokesman for the Department of Public Health refused to explain why nothing was done six years ago, citing department policy. Blumenthal said his office is now looking into possible further legal action against Benet.

At the time that Blumenthal issued his 2002 report, Benet was the founder and medical director of Psych Management Inc., a firm that Anthem Blue Cross-Blue Shield hired to manage mental health care for Anthem's HMO.

Blumenthal found that Anthem's low payments to Psych Management, also known as PMI, combined with financial misdeeds by Benet, resulted in at least one patient, and probably others, being denied necessary mental health care.

"Dr. Benet devised a plan to bilk [PMI] of its assets and profit personally," Blumenthal's report alleges. At the same time that Benet was denying care to patients, Blumenthal contended, Benet was using company funds to support a lavish lifestyle.

"This report presents a picture of a physician driven by the promise of wealth to disregard health needs," Blumenthal said at the time.

Although Blumenthal's investigation was related to the psychiatrist's business practices, and not directly to his own care of patients, the attorney general said he had reason to suspect at that time that Benet could pose a risk to patients. He said his call for revocation or suspension of Benet's license — a move Blumenthal called "highly extraordinary" — was an indication of the seriousness of his concerns.

Earlier this year, Benet agreed to pay a $3,000 fine as part of a consent order he reached with the state in connection with a complaint that Anne Kristine Blake filed. Blake started treatment at Benet's South Windsor office about three months after Blumenthal issued his report in 2002. Although the names of patients who file complaints with the health department are kept confidential, Blake, of Manchester, has come forward and identified herself.

Health department investigators found that during his treatment of Blake, Benet "deviated from the applicable standard of care" by failing to adequately justify his diagnoses of post-traumatic stress disorder and bipolar disorder and by failing to coordinate his prescription for lithium — a drug used to treat bipolar disorder — with the diagnosis that Blake had a thyroid condition, documents show.

In addition to the fine, Benet was ordered to take a class in diagnosing, treating and documenting mood disorders.

The disciplinary action is listed on Benet's physician profile, a public record designed to help would-be patients make more informed decisions when selecting a doctor. It was not, however, reported to the National Practitioner Data Bank, a federal clearinghouse of doctors who have run into disciplinary trouble.

William Gerrish, a spokesman for the Connecticut Department of Public Health, said the federal data bank requires the state to report only reprimands and other more serious disciplinary actions against a doctor's license. He said the state was not required to report the action against Benet because it was only a fine.

Another Case

A second case against Benet is scheduled to be heard by the Connecticut Medical Examining Board at hearings set to begin Sept. 26. The board is a volunteer panel of doctors that works alongside the health department to monitor members of the profession. Cases are usually sent to the examining board when a settlement cannot be worked out between the health department and the doctor.

In that case, a patient identified as P.M. sought care at Benet's South Windsor office in 2004 — two years after the Blumenthal report. In a complaint to the health department, the patient accused Benet of prescribing a dangerous combination of medications.

In a statement of allegations against Benet sent to the medical examining board in May, health department investigators said that Benet prescribed two drugs to treat schizophrenia that could be harmful to people with high blood pressure and Type 2 diabetes, both of which the patient had.

Benet also prescribed five medications for insomnia at once without ordering a sleep study or warning the patient about the possible side effects, which included deterioration of the patient's mental status, the allegations say.

Benet said he would like to respond to the allegations against him, but cannot because he is bound by an obligation to protect his patient's confidentiality. But he maintained that he did not harm either of the patients who made the complaints.

"If you look at the consent decree, it really comes down to technical documentation issues," he said. "In neither case did any harm come to the patient from anything I did or didn't do."

The consent order in the Blake case says that the department reviewed a large sample of Benet's documentation of cases that required coordinating prescriptions for mood disorders and other conditions and found that his "current practice meets the standard of care."

Bad Reaction

Although Blumenthal's allegations against Benet were the subject of press reports, Blake said she found no public records of complaints against Benet when she found his name on the Internet and made an appointment with him in May 2002.

She was recovering from a back injury and had been embroiled in a dispute with the state Department of Mental Retardation, where she had worked with patients in group homes since 1993.

Then on March 14, 2002, she learned that her closest friend, Renea Ervin, then 34, had died. Ervin's husband, Michael Ervin, was eventually convicted of murder and sentenced to life in prison. During the trial, Blake sat in the courtroom, holding her friend's picture.

"It wasn't just little stresses," Blake said. "They were huge."

But she said the medications Benet prescribed made matters worse.

"I couldn't walk, I couldn't talk, I was not a good mother, I couldn't function," Blake said.

After two years of treatment, Blake left Benet's practice.

In July, she sued Benet in small claims court, seeking $5,000 in damages. She wants Benet to cover co-pays on future prescriptions of alprazolam, better known by its brand name, Xanax, and for future psychiatric care.

She said in an interview that she has been dependent on the tranquilizer since Benet prescribed it for her anxiety and panic attacks.

She said she is functioning well now, working as a volunteer on the presidential campaign of Barack Obama and traveling back and forth to Jamaica, where she donates books to poor, rural schoolchildren.

But she says she remains on disability and continues to be unable to work. And she wishes she had been warned before she sought care from Benet.

"I was very vulnerable," Blake said. "I believed he was trying to help me."

Getting the Massachusetts Rx Drug Marketing Reforms Bill Signed

MASSPIRG is an advocate for the public interest in the state of Massachusetts.

When consumers are cheated or the voices of ordinary citizens are drowned out by special interest lobbyists, MASSPIRG speaks up and takes action. They use the time-tested tools of investigative research, media exposés, grassroots organizing, advocacy and litigation.

Last week on August 1st, they released this press regarding the regulation of Drug Company Marketing Practices, etc in the state of Massachusetts.

Legislature Passes Rx Drug Marketing Reforms And Other Measures To Control Health Care Costs

The legislature enacted and sent to the Governor last night a Health Care Cost Control Bill that will begin to reign in aggressive and inappropriate marketing tactics by drug companies and medical device companies. Those excessive marketing tactics have resulted in excessive prescription drug costs and compromised care. Direct-to-physician industry marketing promotes the prescribing of expensive drugs in place of equally safe and effective lower-cost drugs and the prescribing of newer brand name drugs that have the least safety and efficacy information. The excessive marketing of Vioxx, for example, led to the prescribing of a new drug that ended up causing unforeseen heart problems that killed 40,000 people.

“While the bill does not include a complete ban on industry gifts to prescribers it does make a giant step forward in shining the light on this marketing practice through the disclosure of anything of more than $50 value, giving the DPH authority to ban some gifts, and including significant fines for violations of the new regulations,” said Deirdre Cummings, Legislative Director of MASSPIRG.

The final bill also included the following cost control reforms:

RX Drug Marketing Regulations: Requires pharmaceutical and medical device companies to disclose payments to health care providers of $50 or above to DPH which will make the disclosures publicly available. Directs DPH to establish regulations on pharmaceutical and medical device marketing, using the industry’s own Code as a minimum standard, and establishes a $5000 penalty for violation, enforceable by the Attorney General.

Creation of an Academic Detailing Program: A much needed counterweight to the industry’s commercial detailing and gift-giving marketing efforts. Academic detailing programs are cost-effective ways to improve physician prescribing behavior and so reduce health care costs: Based on other states’ experiences with academic detailing programs, Massachusetts can expect to save two to three dollars for every dollar we spend on academic detailing.

Use of Uniform Claim Codes: Currently, nearly one-third of all dollars spent on health care go toward administrative costs – and much of that is wasted on managing the tangle of bureaucratic claim codes created by different insurance plans. Conservative estimates project that the adoption of uniform claim codes will save Massachusetts hospitals over $50 million annually in administrative costs.

Public Reporting of Healthcare-Associated Infections and Serious Reportable Events: Requires facility-specific public reporting of infections, as already required in twenty-two other states and the reporting of, and allows for the nonpayment for, serious reportable events.

Taken together, these provisions will begin to contain the cost of health care in the commonwealth helping Massachusetts citizens continue to have access to affordable health care.

They also have this online petition encouraging Governor Patrick to sign the Bill

Tell Gov.Patrick to stand up to Big Pharma

Big Pharma is a big spender.

They spent $8.2 billion marketing their drugs last year.

And they don't exactly scrimp when it comes to hiring lobbyists to represent their interests on Beacon Hill, either.

Maybe that's why they're so upset that things didn't go their way last week, when the Legislature voted for the Health Care Cost Control Bill, which included reforms to curb drug companies' over-the-top marketing gimmicks.

But Big Pharma isn’t about to back down. They've already set their sights on the one person they think might overturn the decision: Gov. Deval Patrick.

Tell Gov. Patrick to stand up to the pressure and sign the Legislature's Health Care Cost Control Bill into law:

Follow these 3 easy steps to help out.
1. Look over the message below, and feel free to add your own comments. Using your own words makes the message more meaningful.
2. Sign the letter by filling in the form below. We will not share your information with anyone else.
3. Click the button to send your message.

We encourage citizens from the Sate of Massachusetts to sign the petition

Stanford University Removes Chief Psychiatrist Schatzberg From Grant Supervisory Post, Due to Potential Conflict of Interest

As reported in Nature

Stanford University last week removed its chairman of psychiatry, Alan Schatzberg, as principal investigator from a National Institute of Mental Health (NIMH) grant, after a US Senate investigation raised questions about his impartiality in overseeing the grant.

The grant is for investigating the use of mifepristone, a steroid that is being developed for possible use in depression by Corcept Therapeutics, Menlo Park, California, which Schatzberg helped to found and in which he owns 2.7 million shares worth nearly US$6 million.

“Despite our belief that Stanford, NIMH and Dr. Schatzberg have handled this in accordance with the regulations and applicable policies and with due regard to the integrity of the research, we can see how having Dr. Schatzberg as the principal investigator on this grant can create an appearance of conflict of interest and we want to eliminate that concern,” Debra Zumwalt, Stanford's vice-president and general counsel, wrote in a 31 July letter to the NIMH.

A red flag about medicating young children

A column from the Monadnock Ledger-Transcript by Bonnie Harris

World-renowned Harvard child psychiatrist and director of the research team at Mass General Hospital Dr. Joseph Biederman has been found by Sen. Chuck Grassley of Iowa to have failed to report millions of dollars he has received over the years from the drug companies that make the drugs he prescribes for ADHD and bipolar disorder. Biederman and his research team are responsible for putting the diagnosis of bipolar disorder, previously thought to start in young adulthood, on children as young as three.

The reported diagnosis of bipolar disorder grew 40-fold between 1994 and 2003. And that data is five years old. Biederman is the number-one influence on doctors nationwide who diagnose and medicate children with bipolar and attention-deficit disorder. Antipsychotic drugs previously prescribed for adults are now being given to children as young as three -- one of whom died at age 4 from an overdose her mother gave her desperately trying to control her behavior.

According to Medco, a pharmacy benefits manager, 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 who were younger than 6 years old. Biederman claims, "The average age of onset is about four .... It's solidly in the preschool years."

Another 3-year-old was reported by his mother to have violent and explosive outbursts. After a year of treatment, his mother says a psychiatrist told her he thought her son was bipolar. As the boy's mother reported, "He would tell us, you know, 'You donlove me.' ''You don't like me.' 'I don't like myself.' 'I hate myself.' 'I'm stupid.' 'Nobody likes me.' 'I wanna die.' Four-year-olds don't talk like that." After the boy was put on a fourth medication, the family decided that was enough and took their son to Seattle Children's Hospital, where they were told he was not bipolar. He now takes medication for hyperactivity and a sleep disorder. And he's learning to deal with his explosive moods through a behavioral program. The family claims there is no comparison to the child they are parenting today compared to the one diagnosed as bipolar.

Dr. John McClellan, familiar with this boy's case, says the children's psychiatric hospital he runs in the state of Washington is filled with kids who have been misdiagnosed as bipolar. He says it has become a catchall for aggressive and troubled children.

Please, let this report be a red flag to all who have children too quickly diagnosed with ADHD, bipolar disorder, oppositional defiant disorder and others.

A young child claiming that no one loves him, that he's stupid, hates himself, or wishes he could die is often a child who is crying out for acceptance and attention from the influential adults in his life who have yet to understand him and his problems. With that understanding, adjusted expectations, removal of damaging behavior modification techniques such as punishment, many children, even those with chemical imbalances and disorders, can have appropriate behavior without medication. So many children in today's world react strongly to being told what to do and how to do it, to feeling disrespected with regular criticism and punishment, to not fitting in to a schoolroom full of other children who seem to be able to "get it" more easily, to being easily overstimulated or misunderstood for the reasons beneath their behavior.

Children who feel misunderstood are capable of highly inappropriate behavior that is trying to signal their need. They don't know how to say "Hey, this isn't working. My needs are not getting met." So they act it out -- louder and more dramatically the longer the misunderstanding. One of the children diagnosed with bipolar disorder had a father who had been accused of abuse. This factor was not part of the equation of the diagnosis.

We must look to the reasons -- the root causes -- of why our children don't, won't or can't do what we ask. Diagnoses often feel validating and relieving when our attempts at control don't work to get our children to comply. We can shift the blame onto to "problem" and we don't have to change how we parent.

Let me be absolutely clear that I do not consider the parent to blame. It is the culture in which we live that does not support parents to support their children. We are still in a children-must-do-as-we-say mentality and if they don't -- well now we can medicate them and we don't have to deal with it. Let me also say that are many cases in which medication is helpful and necessary.

But please lets start to put more effort into understanding children, their temperaments, the reasons for their behavior, their need for acceptance and compassion, their desire to get it right and their frustrations when they can't.

Let's not medicate those frustrations before thorough evaluations can be conducted by several professionals looking at the behavior from different perspectives.

And please let's take some responsibility for what we, their parents and teachers, are presenting to our children that become triggers for disruptive behavior.

---

Bonnie Harris, M.S.Ed,. is the director of Connective Parenting. Past columns can be found on her Web site, http://www.connectiveparenting.com. E-mail questions or topic requests to bh@bonnieharris.com.

Mentally retarded child beaten up by an angry caregiver at Denton State School in Texas

From a much longer article in the Houston Press

Every day she comes here to be with him — to wash his wiry hair and clip his yellowed nails and rub his calloused feet. The boy has no control over his body. His head rolls from side to side, his eyes dart from one thing to another and drool pools out of his mouth. His name is Haseeb, and he is 34.

He wasn't always like this. For most of his life, he has been profoundly mentally retarded, but there was a time when he could sing and dance and communicate with his mother, in broken English and Urdu. There was a time when he ate cheeseburgers with his family and bopped his head to his brother's hip-hop.

And then something happened.

Six years ago, not far from where Chishty sits, a nurse's aide found Haseeb in bed, soaking in his own blood and urine. No one at the school could explain what happened. For six months he lay in intensive care, suffering from massive internal injuries that triggered toxic shock and then paralysis. His mother insisted someone at the school was to blame — she had seen a bruise in the shape of a footprint near his groin on the morning they found him. But no one had reported any abuse, so her claims went ignored.

For two and a half years, she told this story to anyone who would listen, and then the unexpected happened. Kevin Miller, a former caregiver at the school, admitted he had abused Haseeb in a drug-induced rage, punching and kicking him more than a dozen times. He said his supervisors knew about the attack and helped him cover it up. Even more alarming, he said abuse at the school was rampant. He knew his confession, which he first offered at a drug rehab clinic in Houston, might send him to prison, but he felt it was worth the risk if it sparked reforms.

More than three years have passed since then, and none of the changes Miller envisioned have taken place. Yet largely thanks to Chishty's efforts, her son has become the face of a movement. For the first time in nearly a decade, advocacy groups for the mentally retarded are pushing for the closure of the 13 state schools in Texas. These facilities, which house nearly 5,000 people, represent the largest institutionalization of mentally retarded in the nation. The alternatives — smaller, community-based group homes — are cheaper, safer and more humane, mental health rights advocates say. The trend across the country is toward this model of care, and other states, including California and New York, have either shuttered their institutions or are in the process of doing so.

Jeff Garrison-Tate, who heads Community Now, an Austin-based advocacy group, cites the Chishty tragedy as a defining example of why Texas should close all its state schools. "Haseeb is the tip of the iceberg," he says. "By their very nature, these are places where abuse is rife to occur."

Cherry Hospital psychiatrist struck a mentally ill patient

From North Carolina's News & Observer Newspaper

A psychiatrist at a state mental hospital in Goldsboro is still on the job despite an internal investigation that concluded he hit a mentally ill teenager who has developmental disabilities.

Dr. Ralph Berg, 58, struck Ricky Luciano in the back during a tussle over a T-shirt at Cherry Hospital. The incident, which occurred April 28, was recorded on a hospital security camera.

Berg, reached at his home Friday, said he had been instructed not to comment about the case.

According to the hospital's internal investigative report, released at the behest of Luciano's family, Berg told hospital officials he was defending himself after Luciano, then 18, bit him on the forearm.

Even if Berg was attacked, a state law regarding the use of force in mental hospitals bars staff from retaliating with violence.

The assault was not reported to any law enforcement agency, including Cherry's internal police department.

A review of public files at the N.C. Medical Board gives no indication a complaint was filed against the doctor, who has been on the state payroll since 1999 and receives an annual salary of $187,681.

"He should have been fired," said Deborah Sargis, Luciano's mother. "I've been a nurse more than 20 years. Had I ever seen anything like that when I was working, I would have reported that doctor in a minute."

On the recording

The recording, which the state Department of Health and Human Services did not disclose until pressed by The News & Observer, shows Luciano standing in a hospital day room at 8:37 a.m. with his shirt off, snapping it at two staff members in front of a nurse's station.

Berg enters through a door and attempts to snatch the shirt from Luciano. The two tug at it, spinning around before Luciano appears to dip his head toward the doctor's hand. As the patient is bent over, Berg strikes him in the back, and Luciano collapses to the floor.

The doctor throws the shirt to the floor before grabbing it and leaving through the same door he entered. Luciano, who is schizophrenic and has an IQ of 58, is left sitting on the floor with his head bowed until the tape, as edited, ends.

The written report of the incident included in Luciano's medical file indicates he bit the doctor, who "pushed" the patient to make him release the bite.

A handwritten note that says "no injury to client" was crossed out and replaced with "Error. Reddened area L[eft] shoulder blade." The mark, which later darkened to purple, measured about 4 inches square.

Afterward, records indicate Luciano was given the maximum recommended dose of an anti-psychotic drug, along with anti-anxiety and mood-stabilizing drugs. When administered together, the drugs would have heavily sedated the patient.

An internal investigation was launched that day, after the incident was reported to one of the hospital's patient advocates. In an interview with Berg transcribed in the file, the doctor said he tried to grab the shirt only after Luciano snapped it at him.

"He locked his jaw into my arm," Berg is reported as saying. "As he was locked on me, I went to push him down, and he moved up a bit, and it wound up slapping him on the back. ... I feel badly that it went down like that, but I am going to stand by my guns that I didn't do anything wrong."

Nurses and lower-ranking employees at state hospitals are routinely fired if an abuse complaint is substantiated against them, and their names are placed on a blacklist that makes it difficult for them to find another job.

According to the investigative report, the Cherry officials who reviewed the complaint against Berg recommended that a supervisor "address how the intervention used was not appropriate and discuss how the situation could have been handled differently."

If You Think There is a Risk Then Why on Earth Are You Releasing Him?

From the Derby Evening Telegraph

A Transcript reveals how a doctor was warned by a police inspector about the risk of releasing a patient who threatened to torch his house - 24 hours before he set himself on fire and died.

It shows Inspector Alison Dando telling psychiatrist Dr Raj Sinha that, if anything happened to Andrew Whetton, "it would look bad on the health authority".

The 48-year-old begged to be kept in hospital and threatened to set fire to his house but was released from the mental health unit.

The next day, he covered his clothes in petrol and set them alight while in a car with his partner of 25 years, Julie Croft, in Marston Lane, Hatton.

Coroner Dr Robert Hunter recorded a verdict of suicide at the end of a two-day inquest yesterday.

However, he said the fact Mr Whetton was not given a mental health examination by a senior psychiatrist after the suicide threat was a "contributing factor in his death".

Dr Sinha rang police to let them know Mr Whetton was being released.

After a recording of the call Dr Sinha made to police was played in court, he said: "Too much pressure was coming to me at that time. It was not an ideal situation.

"We do not have a machine to say what this patient will do."

[...]

Dr Robert Rowlands, an independent psychiatrist asked to look at Mr Whetton's medical notes, also questioned the decision not to carry out an assessment.

He said: "People being agitated to the point of pleading on their knees - that's an unusual level of agitation. If you have ended up on a psychiatric ward, you are a high risk.

"Dr Gupta did not actually review the patient himself. That would have been the prudent thing to do."

The inquest heard how Mr Whetton could not be sectioned under the Mental Health Act as he wanted to stay in hospital.

Summing up, the coroner said: "Mr Whetton was agitated, he fell to his knees pleading with staff not to discharge him. The team were collectively concerned to inform the psychiatrist, but no formal examination was made. The consultant psychiatrist did not see him. As a result of that decision, it was agreed he should be sent on home leave. I find that this was a contributing factor in Mr Whetton's death."

The Perils of Industrial Mental Health: Documents were forged, and falsified,

From the Philidelphia Inquirer

The social workers who were supposed to watch over 14-year-old Danieal Kelly didn't do much of anything while she slowly died of starvation and neglect.

But they got very busy after she died, according to a grand-jury report.

The call came Aug. 4, 2006. She'd been found dead, looking like a victim of a concentration camp, with rotting bedsores and weighing 42 pounds.

That afternoon, workers for MultiEthnic Behavioral Health Inc. scrambled to forge documents to make it look as though they had been visiting the girl and her family, as they were being paid to do by the city's Department of Human Services.

In the months before the girl's horrific death, the workers for MultiEthnic were not the only ones who failed to do their jobs - or to try to cover their tracks afterward - according to the grand-jury report.

"The fate of a sweet and promising child depended on the willingness of a number of particular adults to do the bare minimum of what they were supposed to do," the report says.

". . . Had just one of them performed their duty or done their job, Danieal would be alive today."

The DHS caseworker assigned to the family, Dana Poindexter, ignored warnings that the girl was at grave risk, the report alleges, and later lied to the grand jury to make it appear he had been doing his job.

Months after her death, a homicide detective found the case file - at the bottom of a box filled with food wrappers and dusty unopened letters, some of which were four years old.

Poindexter testified he didn't know that Kelly was entitled to go to school, or that it was against the law for a parent not to provide necessary care. "He must have been asleep during his training," one expert told the grand jury.

Pressed to provide a summary of the case a year before her death, Poindexter wrote an account that the grand jury called "pathetic," "self-serving," and "almost certainly false."

Poindexter, who had been suspended three times for poor performance, testified that he prepared many documents and put them in the Kelly case file.

"The grand jury has no doubt that he never prepared these documents," the report said. He is charged with perjury, along with endangering the welfare of children.

Reached by phone, Poindexter, 51, declined to comment. He was suspended again by DHS yesterday.

Another DHS worker, who did not bother to enter the girl's room during her last visit, backdated her report, the grand-jury report said.

And a supervisor admitted she falsified case records to make it seem that DHS had investigated old neglect reports involving the Kelly family and found them "unsubstantiated." Called to testify, she told grand jurors that was common practice at DHS; she said it was a bureaucratic procedure that helped hasten services to families.

That supervisor, Martha Poller, is still with DHS and recently was given a new job: project manager for a team that will examine child-fatality cases. During a news conference yesterday, District Attorney Lynne M. Abraham said she was incredulous that Poller had been entrusted with that new duty.

Poller did not return phone calls yesterday seeking comment.She was not charged.

The 258-page report brims with outrage and fierce criticism of the people involved in Kelly's case - not just of the nine people who were charged, but also the people who ran DHS, the investigators who responded to the death, and even a Public Health Department official who tried to squelch her employees from talking about the case.

The findings in the report echoed, in part, the findings of a DHS review panel that found deep problems at DHS and suggested sweeping reforms.

"What I can tell you is: The internal accountability was weak, and the demand for external accountability from providers was equally weak," said Carol Spigner, the head of the panel.

"When that happens, there are a lot of risks in the system."

The grand-jury report found that the management failures began years ago, before Danieal Kelly even arrived in Philadelphia.

DHS workers complained that MultiEthnic was not visiting families as required and was falsifying records to cover it up.

An investigator for DHS found that the fraud charges were likely true. But the agency wasn't fired. Cheryl Ransom-Garner, who later became DHS director, summoned Mickal Kamuvaka and the other directors of the agency and "read them the riot act," the report said.

Later, a DHS evaluation lauded MultiEthnic for its "energetic" performance, calling it "remarkable." When called before the grand jury, Ransom-Garner said she didn't remember hearing any complaints about the agency - a response the grand jury called "incredible."

Ransom-Garner did not return calls seeking comment. Kamuvaka could not be reached for comment.

These missed chances to check up on MultiEthnic would be repeated again and again, the report found.

The agency's caseworker assigned to the Kelly family, Julius Murray, allegedly visited the home only a few times, and the investigation found no evidence he ever met the child.

In previous cases, Murray and other caseworkers allegedly would have families sign batches of blank forms, attesting to visits that never happened. Murray is charged with doing the same thing in the Kelly case.

The fraud was no aberration - "it was MultiEthnic's modus operandi," the report said.

After the girl's death, the grand jury found, the cover-up kicked into high gear.

A secretary, Vanessa Jackson, was told to come in on her day off on orders from Kamuvaka, "Dr. K." The problem: DHS was coming over for the Kelly family file at 4 p.m., and "Dr. K didn't have much of a file."

She was put to work fabricating notes for home visits that never happened, while another employee sat forging quarterly reports.

"I don't want them to test the notes for the ink to see if they had been written earlier," Jackson quoted Kamuvaka as saying.

They kept a courier from DHS waiting for 20 minutes while they assembled the file.

Like Poindexter, the next DHS worker to get the case, Laura Sommerer, didn't find anything wrong with MultiEthnic's performance. She visited the home June 29 and allegedly saw nothing amiss. She later said she didn't try to speak to the girl.

After the girl died, Sommerer's boss asked her for her report on the June visit; she gave it a day or two later.

But after investigators analyzed her computer, Sommerer admitted she didn't write the report until after the girl died. The grand jury called that "an obvious attempt to cover up her negligence."

During the investigation, the top official in the Health Department also tried to squelch information about the case, the grand jury said.

The doctor who performed the autopsy, Edwin Lieberman, said he was told to keep quiet about the case by Carmen Paris, then the department's acting commissioner.

Edward McCann, who heads the homicide unit for the District Attorney's Office, said that Paris told him it was a miscommunication.

Donald Schwarz, deputy mayor for health, said Paris was suspended pending a hearing today.

In October 2006, after The Inquirer published reports on deaths of other children under DHS supervision, Ransom-Garner at first prepared a counteroffensive - an opinion piece attacking the paper's findings.

She admitted that she didn't bother telling Mayor John F. Street much about the Kelly case "because it wasn't in the press."

But then someone showed Street the photographs of Danieal Kelly. The next morning, on Oct. 20, she was called into the office of Managing Director Pedro Ramos.

"This is the case that is going to take the mayor down," Ransom-Garner quoted him as saying.

There would be no opinion column. Instead, Street fired Ransom-Garner and her top deputy.

Karadzic’s alter ego

More on the prospects for mad psychiatrist Radovan Karadzic.

The July 30 extradition of former Bosnian Serb leader Radovan Karadzic to the Netherlands, following his July 21 arrest, put an end to many years of efforts to bring one of the world’s most wanted fugitives to justice. After 12 years on the loose, Karadzic will face charges of genocide and crimes against humanity, committed during the 1992/95 war in Bosnia, before the United Nations war crimes tribunal for the former Yugoslavia in The Hague.

Many people remain shocked that the one time president of Republika Srpska, allegedly responsible for carrying out massive ethnic cleansing during the Bosnian war, was living a normal life in Belgrade, just like any ordinary citizen. Those more familiar with his numerous transformations, however, were not as surprised.

A graduate psychiatrist, poet and politician, Karadzic was captured spending his days practising alternative medicine, giving lectures, contributing to a health magazine and even running his very own website. Pretty bold, many would say, but, on second thought, these proved to be quite successful tactics because media reported a number of people who have known and been in touch with “Dr Dragan Dabic” are utterly stupefied after finding out who he really was.

[...]

In spite of being officially married to psychiatrist Ljiljana Zelen-Karadzic, with whom he has two children, Sasa and Sonja, Karadzic was reported to have a girlfriend, Mila, during the time he spent as Dr Dabic. She often accompanied him to his lectures and was introduced, by Karadzic, as his associate, media reports claim.

Zoran Pavlovic, the software engineer who worked on Dabic’s website, told the AP Karadzic had a framed photograph of four boys in his two-room apartment in the suburb of New Belgrade, who he claimed to be his grandsons living in the US. Karadzic said he had lived in New York, where he had earned his diploma. “He told me he travelled often to America and I had no reason to disbelieve him,” the software expert told the AP.

Karadzic did not miss out on social life either, as reports say he frequently visited the Madhouse bar in his neighbourhood. There, he enjoyed drinking red wine and listening to the traditional gusle, which he occasionally got to play himself. On its walls, the small pub had pictures of him and his one time close associate Ratko Mladic, the chief of staff of the Bosnian Serb army during the Bosnian war and the next top wanted fugitive on the list of The Hague tribunal.

As the days of healer Dabic are now over, Karadzic has removed the long beard and hair hiding his face. He has also announced he would defend himself at the tribunal. However, how could any defense rebut the charges, as the war in Bosnia saw the worst atrocities in Europe since the end of World War Two?