Psych Watch: November 2014

Friday, November 28, 2014

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

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

Psychiatric drugs responsible for 90,000 ED visits annually

The original study is

Emergency Department Visits by Adults for Psychiatric Medication Adverse Events

Adverse reactions to antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulant drugs are responsible for almost 90,000 emergency department (ED) visits each year by US adults, according to a study in JAMA Psychiatry. The authors estimated the number of emergency department visits for adverse drug events from the therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants using active, nationally representative surveillance data from the National Electronic Injury Surveillance System – Cooperative Adverse Drug Event Surveillance (NEISS-CADES). They also estimated the number of outpatient visits at which those drugs were prescribed using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. They used the estimates of ED visits for adverse drug events and of outpatient prescription visits to calculate the number of ED visits for adverse events from a particular psychiatric drug per 10,000 outpatient prescription visits at which the drug was prescribed. Almost 1 in 5 of those ED visits (19.3%) resulted in hospitalization. Sedatives and anxiolytics, antidepressants, and antipsychotics each caused 20,000 to 30,000 ED visits annually. However, relative to how often each of these types of medications was prescribed at outpatient visits, antipsychotics and lithium salts were more likely to cause ED visits for adverse drug events than were sedatives, stimulants, and antidepressants. Antipsychotics caused 3.3 times more ED visits for adverse drug events than sedatives, 4.0 times more ED visits than stimulants, and 4.9 times more ED visits than antidepressants relative to their outpatient use. Out of the 83 specific drugs the study looked at, 10 drugs were implicated in nearly 60% of the ED visits for adverse drug events from therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants. Zolpidem was implicated in nearly 12% of all such ED visits and 21% of such ED visits involving adults aged 65 years or older, more than any other sedative or anxiolytic and more than any antipsychotic, antidepressant, lithium salt or stimulant. “The study highlights the importance of encouraging doctors to be cautious in their prescribing of medications,” said one of the study’s leaders Lee M. Hampton, MD, of the Centers for Disease Control and Prevention's healthcare quality promotion division. “The study findings can also be used to prioritize efforts to reduce the burden of adverse events from the therapeutic outpatient use of psychiatric medications within a given managed care or healthcare system.” [...]

Thursday, November 27, 2014

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

As reported in the Imperial Valley News

The former chief operating officer of a Miami-area hospital pleaded guilty today for his role in a mental health care fraud scheme that resulted in the submission of more than $67 million in fraudulent claims to Medicare by a state-licensed psychiatric hospital located in Hollywood, Florida, that purported to offer both inpatient and outpatient mental health services. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Derrick Jackson of the U.S. Health and Human Services Office of Inspector General’s (HHS-OIG) Florida region made the announcement. Christopher Gabel, 61, of Davie, Florida, the former Chief Operating Officer (COO) of Hollywood Pavilion LLC (HP), pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and pay and receive health care kickbacks. Gabel was charged in an indictment returned on May 8, 2014. According to Gabel’s admissions in connection with his guilty plea, between April 2003 and September 2012, HP submitted false and fraudulent claims to Medicare for treatment that was not medically necessary or not provided to patients. As COO during that time, Gabel supervised HP’s staff at both its inpatient and outpatient facilities, where Medicare beneficiaries were admitted to HP regardless of whether they qualified for mental health treatment, and were often admitted before seeing a doctor. Gabel admitted that HP obtained Medicare beneficiaries from across the country by paying bribes and kickbacks to various patient brokers. Gabel instructed the patient brokers to falsify invoices and marketing reports in an effort to hide, and cover up the true nature of the bribes and kickbacks they were receiving from HP. From 2003 through August 2012, HP billed Medicare approximately $67 million for services that were not properly rendered, for patients that did not qualify for the services being billed, and for claims for patients who were procured through bribes and kickbacks. Medicare reimbursed HP nearly $40 million for those claims. Karen Kallen-Zury, Daisy Miller, Michele Petrie and Christian Coloma were convicted at trial in June 2013 for their roles in this scheme. Kallen-Zury, HP’s former chief executive officer, was sentenced to 25 years in prison. Miller, the clinical director of HP’s inpatient facility, was sentenced to 15 years in prison; and Petrie, the head of HP’s intensive outpatient program, was sentenced to six years in prison. Coloma, the director of physical therapy for an entity associated with HP, was sentenced to 12 years in prison. Kallen-Zury, Miller and Petrie were ordered to pay nearly $40 million in restitution, and Coloma was ordered to pay more than $20 million in restitution. The case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. The case is being prosecuted by Trial Attorneys Nicholas E. Surmacz, Andrew H. Warren and L. Rush Atkinson of the Criminal Division’s Fraud Section. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: http://www.stopmedicarefraud.gov

Wednesday, November 26, 2014

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

A Report from the LA Daily News

Scrutiny of doctors who prescribe psychotropic drugs to California foster children intensified this week, with growing calls for regulators to consider whether financial relationships with pharmaceutical companies may be driving the excessive use of medication. The outcry came from a leading consumer advocacy group as lawmakers stepped up their efforts to rein in reckless prescribing and the California Medical Board vowed to widen its investigation in response to this news organization’s ongoing series “Drugging Our Kids.” On Sunday, the news organization reported that prescribers in the foster care system received more than twice as much as the typical California doctor in payments from big drug companies for meals, gifts, travel, speaking and industry-sponsored research. The news organization also found that last year doctors who prescribed the most to California foster youth, on average, accepted almost four times as much as those who fell in a lower-prescribing group. “We’ve known for years that the problem of drug manufacturer payments to doctors appears to have an outsize influence in their prescribing practices,” said Carmen Balber, executive director of the nonprofit group Consumer Watchdog. “But this investigation was particularly disturbing because of the patients it affects. The conflict of interest is clear in these cases and we think that action is long overdue.” In a letter to the California Medical Board sent earlier this week, Balber’s Santa Monica-based organization called on the state licensing agency to expand its current investigation of doctors who may be overprescribing to foster youth “to determine if children are inappropriately being prescribed or overprescribed because of drug manufacturer payments to their physicians.” Balber said the prescribing has not only cost taxpayers millions of dollars in payments for possibly unneeded drugs, but has also put the children’s health at risk. The news organization’s report on industry ties, she added, “makes clear that the state has failed to take the steps necessary to protect children.” Kimberly Kirchmeyer, executive director of the California Medical Board, noted there is no law prohibiting doctors from accepting drug industry promotional funds. The news organization found pharmaceutical companies spent more than $14 million to woo foster care prescribers from 2010 to 2013. But the payments may constitute “unprofessional conduct,” Kirchmeyer added, and that could warrant additional scrutiny. She said the agency plans to look into whether these doctors “have a reason to prescribe, are they appropriately prescribing, or are they prescribing medication inappropriately to support the pharmaceutical company?” The medical board has been looking into whether specific doctors are over-prescribing psychotropic medications to foster youth since the news organization published its first installment of “Drugging Our Kids’’ in August, which revealed that almost one in four foster teens are prescribed psych meds. Many of the drugs are being prescribed to control troublesome behavior instead of the severe mental illnesses they are approved to treat. They can have debilitating side effects, such as rapid weight gain, higher risks of diabetes and severe lethargy. The news organization’s original findings drove state Sen. Jim Beall, chairman of the Senate Human Services Committee, to push for more detailed information from the state Department of Health Care Services on prescribing practices to foster youth. On Monday, Beall, D-San Jose, met with California’s director of social services, Will Lightbourne, to discuss the request he and Los Angeles Democratic state Sen. Holly Mitchell submitted to health care officials last week. The two senators have called on Health Care Services Director Toby Douglas to release geographic and demographic information on prescribing patterns, including tallies of foster children on multiple medications and high doses, as well as those being prescribed drugs for conduct “disorders” — more information than the state has been willing to release so far. Beall said he will use the data to draft legislation aimed at improving the oversight and monitoring of psych medication use in foster care. The bill could require regular reports and analysis of county-level prescribing trends and establish a hotline for lawyers, judges, doctors and other caregivers who need guidance on medication. On Monday, after the news organization’s latest report, Beall said he also wants doctors’ interactions with drug companies to be better monitored. “The Social Services Agency should take all steps to ensure that there’s no conflict of interest in medical care for any of our foster kids — and if that’s happening right now, we’re going to take action in the Legislature to make sure that doesn’t happen,” Beall said. State Sen. Ted Lieu, D-Redondo Beach, who in August called for a state investigation into psychotropic drug prescriptions for minors in the wake of the initial series of news reports, echoed the more recent calls by his fellow state legislators to make the additional information public. “I’m pleased that the California Medical Board had initiated an investigation, but now has expanded it,” said Lieu, who was just elected to Congress. “I believe the investigation by the newspaper has raised some very troubling questions about how psychotropic drugs are being administered to foster youth.” Marilyn Benoit — the former president of the American Academy of Child and Adolescent Psychiatry and current chair of the academy’s task force that proposed guidelines on relations with drug companies — said the news organization’s unique look at foster care prescribers’ link to drug companies is “concerning.” “This is a capitalistic country — you’re supposed to market and advertise the products you make — there’s nothing wrong with that,” said Benoit, a child psychiatrist who oversees a Pennsylvania-based behavioral health center that treats foster youth. “But as prescribers, we have to be more scrutinizing and understand the difference between marketing and real scientific information about the medication we use.” Yet Benoit cautioned that although “research clearly shows that doctors can be influenced by gifts,” her organization is advisory only, and has no enforcement capabilities. She said doctors must take personal responsibility to draw the line. “When you’re tied to the pharmaceutical industry,” Benoit said, “then there could be a conflict of interest in your prescribing behavior.”

Tuesday, November 25, 2014

Court expert for the Los Angeles Unified School District argues that a girl with low IQ may suffer less after sex assault

As Reported on 89.3 KPCC Radio

A psychologist hired by the Los Angeles Unified School District (LAUSD) testified last year that a 9-year-old girl's low IQ provided a "protective factor" that could reduce the amount of emotional stress she experienced from a sexual assault, according to court records examined by KPCC. Dr. Stan Katz made the statements during the May 2013 trial over how much in damages the girl was entitled to after being repeatedly sexually assaulted by a boy at her school. The girl has an IQ between 64 and 70; the boy who assaulted her was not developmentally disabled, according to court transcripts. The abuse happened at various spots around the school campus, according to David Ring, the girl's attorney. Her family sued LAUSD, arguing the girl needed financial compensation because she suffered significant trauma and would need long-term therapy. "Protective factor" At trial, Ring asked Katz what he meant when he had testified that the girl's mental disability "acts as a protective factor." According to the court transcript, Katz answered, "There's a relationship between intelligence and depression. What happens is the more you think about things, you can ruminate, you can focus on things, you can look at the complexities of the matter and become more depressed." Following up, Ring asked, "So because she may be less intelligent than a general education student, she's going to suffer less depression because of it?" Katz replied, "Very possible, yes." Katz didn't deny that the girl had suffered, and he said she would require therapy to deal with the trauma. The assaults against the girl occurred in 2010, when she was 9 years old. Katz testified that when he interviewed the girl in April 2012, whatever emotional problems she may have had at the time were a result of not having her father in her life and her mental disability, not the molestation. "I have handled hundreds of cases where the experts have given depositions, and I've never heard [the protective factor argument] in the way it was said" in this case, said Ring. Two experts in the field reviewed Katz's testimony and said there is no science to support his assertion about the protective factor. "I have never seen developmental disability in a child that age used as a protective factor with respect to how they handle trauma," said University of California San Francisco psychiatrist Dr. Lynn Ponton. "In fact," she added, "developmental disability quite often puts them at risk for this type of trauma." Dr. Steven Berkowitz, an associate professor of Clinical Psychiatry at the University of Pennsylvania Perelman School of Medicine, agreed. A mentally disabled person who has undergone a traumatic experience may have a "compromised" ability "to fully understand why something may have happened" or "the consequences for themselves and others," said Berkowitz, who is also director of the Perelman school's Penn Center for Youth and Family Trauma Response and Recovery. That person may also have difficulty with "decision making or problem solving around the use of coping strategies to assist them in dealing with the stress or trauma," he said. Asked about Dr. Katz' protective factor argument on behalf of the school district, LAUSD Associate General Counsel Greg McNair said he hadn't read the trial transcripts, but added, "I don’t know anything about that. I would not agree with that. I think anyone who has been involved in a traumatic event would suffer tremendously." Katz did not return repeated calls seeking his comment. "The jury was offended" The jury in the case awarded the girl $1.4 million in damages, far more than the $10,000-$12,500 LAUSD attorney Keith Wyatt argued she needed for therapy sessions. "The jury was offended, they were disgusted and they thought it was unbelievable that an expert witness could come in and say something like that," Ring said, referring to post-trial conversations he had with jurors. Members of the L.A. Unified Board of Education did not respond to requests for comment, although it's unclear how familiar they are with the details of the case. According to LAUSD counsel McNair, the board does get a brief, called a trial informative, at least thirty days before a trial, which describes the facts of the case and the positions of the district and plaintiffs, but daily briefings are unusual. "It's a rare case when we would provide a daily update to the board on a case," said McNair. "I get daily updates on every trial that takes place," he said, adding that he's typically tracking about 100 lawsuits "more or less" at any one time. Marci Hamilton, a professor at the Benjamin N. Cardozo School of Law in New York, believes it's important that LAUSD keep its board well informed about ongoing litigation. "What I wonder is whether or not the LAUSD actually knows what its experts and its lawyers are arguing, because this is beyond the pale for any school district that is supposed to be, under law, caring for children," said Hamilton. Even though Katz's comments on the protective factor were just a small part of his testimony in this case, Hamilton expressed concern that L.A. Unified might try to use the same argument in future lawsuits, a prospect she found "disturbing." Katz has become something of a celebrity through his appearances on several reality TV shows, including "It's Complicated" with actress Denise Richards. But he said in court that most of his time is spent as an expert witness and mediator in child custody disputes. For the past ten years, he's worked on several cases, including some LAUSD child abuse cases, with Wyatt's firm of Ivie, McNeill & Wyatt. Dr. Katz is consulting on another child abuse case involving a former teacher from Hamilton High school. That case is scheduled to go to trial in February and Ivie, McNeill & Wyatt has been retained to defend LAUSD, district officials said. Keith Wyatt will not be the lawyer from his firm trying the case because the district said he will no longer represent it in any lawsuits following remarks he made to KPCC about his handling of another sex abuse suit.

Monday, November 24, 2014

Drugging our kids: RX alliance rewards doctors as drug companies get richer

An Investigative report by the Los Angeles Daily News

The following is from a much larger article well worth reading:

An investigation by this news organization has found that drugmakers, anxious to expand the market for some of their most profitable products, spent more than $14 million from 2010 to 2013 to woo the California doctors who treat this captive and fragile audience of patients at taxpayers’ expense. Drugmakers distribute their cash to all manner of doctors, but the investigation found that they paid the state’s foster care prescribers on average more than double what they gave to the typical California physician. The connection raises concerns that Hernandez and many other unsuspecting youth have been caught in the middle of a big-money alliance that could be helping to drive the rampant use of psychiatric medications in the state’s foster care system. “It sucks that the people marketed it that way, but that’s not that shocking. I’m more mad at the doctors for just going along with it,” said Hernandez, 22, who was prescribed as many as four of the drugs at a time as a foster youth in Southern California. Overall, drugmakers reported payments to 908 doctors — well over half of those who prescribed psych medications to the state’s foster children, according to this news organization’s analysis of prescribing data and four years of pharmaceutical company payments compiled by the public interest journalism nonprofit ProPublica. And those who prescribed the most typically received the most, the analysis found. The results provide the most comprehensive look to date at the pharmaceutical industry’s influence on the doctors who treat the 60,000 kids in the country’s largest foster care system — a lucrative target because Medi-Cal pays the bill with little scrutiny. One Sacramento doctor raked in more than $310,000 in four years to give promotional speeches and an extra $8,500 in meals, records show. Another 224 doctors each got more than $500 in meals, and two of them each received more than $20,000 for travel. The biggest payments went for research, with two Southern California doctors each receiving more than $2 million to conduct drug company-sponsored trials. Doctors who accept the drug companies’ offerings say they aren’t influenced, and the pharmaceutical industry defends its partnerships as a necessity for developing the lifesaving drugs of tomorrow. “The kind of medical innovation that we have in this country wouldn’t happen without a robust dialogue between industry and physicians,” said John Murphy, assistant general counsel for the Pharmaceutical Research and Manufacturers of America. But critics say the drug companies are disguising investments in the name of science to reward doctors who in turn boost the industry’s bottom line. “These figures suggest these doctors are not looking out primarily for the kids’ interests,” said UCLA social welfare professor David Cohen, who has studied medication use in the foster care system and drug company influence. “They suggest many doctors are looking out for their financial interests, and we should all be wary.” The findings are especially disturbing because of the growing evidence that psychiatric drugs are being overprescribed to California’s foster children despite their significant side effects, the subject of this news organization’s yearlong investigation “Drugging Our Kids.” The news organization previously reported that almost 1 in every 4 adolescents in California foster care has been prescribed psychotropic medications, often to manage troublesome behavior rather than treat the severe mental illnesses for which they are approved. While the federal government has cracked down in recent years on how drug companies market powerful antipsychotic drugs to the elderly and children, the industry’s investment in courting doctors appears to still be paying off: California taxpayers spend more on psychotropic drugs than on any other kind of medication prescribed to foster children, according to a decade of Medi-Cal spending data revealed by this news organization in August.

This is only the tip of the iceberg

How the LA Daily News investigated financial ties between drug manufacturers and doctors who prescribed psychotropic medications to California foster children from July 2009 to July 2014

According to their report

The news organization analyzed financial ties between drug manufacturers and doctors who prescribed psychotropic medications to California foster children from July 2009 to July 2014. The Prescribers: We started with a list of prescribers obtained through a public records request from the state Department of Health Care Services. The list identified prescribers’ names, addresses and whether they wrote more than or fewer than 75 prescriptions for psychotropic medications each fiscal year. The state did not provide data to show precisely how many prescriptions each individual wrote. The Dollars: We matched the 1,647 prescribers with physicians in a database of drug company payments, compiled by the journalism public interest nonprofit ProPublica, called “Dollars for Docs” — http://projects.propublica.org/docdollars. The organization has built the most comprehensive public database to date of drug company spending on doctors and health care institutions, with more than $4 billion in payments nationwide. The Limitations:The news organization’s analysis doesn’t catalog all spending on prescribers because in the four years examined just 17 drug companies and not the entire industry revealed what they spent on doctors, many under corporate integrity agreements with the Inspector General of the U.S. Department of Health and Human Services. The Analysis: Because of the limitations of the drug company reports, the news organization considered a four-year period of spending instead of a year-by-year analysis. The Matching: There were some inconsistencies in the way drug companies reported doctors’ names. Sometimes doctors were listed as payees. Sometimes a related entity, such as a clinic, was listed as the payee with the doctor shown as affiliated with the entity. The news organization aggregated totals for all payments to doctors and related entities under the doctor’s name. Part of the total may represent payment to others for the doctor’s services.

Sunday, November 23, 2014

FSU shooter like many other killers was on psychiatric drugs

As seen online in the Examiner

There has been a fairly detailed account emerging about Myron May, who was a lawyer and Florida State Alumnus (FSU), as the most recent in a long line of mass shooters who was under the influence of psychotropic drugs. Headlines in the syndicated press have focused on May’s alleged paranoia and deteriorating mental state. However, May's friends have offered more detail about May’s life in the events leading up to the attack. Keith Jones, May’s former roommate, says there's more to the mental health status of May which may have been responsible for this. Jones says May was taking medications which caused paranoia at the time of the shooting. May's old girlfriend Danielle Nixon has also said May was taking prescription drugs. Although the exact number of drugs May was taking still is not clear, according to ABC Action News there was a half-filled prescription for Hydroxyzine inside May’s apartment. This is commonly known as an antianxiety drug. May had recently been practicing law in New Mexico when the shooting took place. He had no history of violence or self-harm until he suddently shot three people in the FSU Library. This is a characteristic story of a mass shooting by someone on psychotropic drugs wherein friends and family report they were shocked with the shooter’s uncharacteristically very violent actions. There is a long list of mass shooters who either were on or withdrawing from psychiatric drugs at the time of their deadly attacks. There are accounts of at least 18 people who committed acts of violence when they were under the influence of psychiatric drugs. Four of these people were seeing either a psychiatrist or psychologist at the time. And this account does not include the 34 school shootings and/or school associated acts of violence that have been committed primarily by minors or teens who were taking or withdrawing from psychiatric drugs. There has been a common denominator in these mass killings wherein the psychiatric drugs they were taking or withdrawing from are documented by 22 international drug regulatory warnings to actually cause mania, hostility, violence and even homicidal ideation. Furthermore, between 2004 and 2012, there have been 14,773 reports to the U.S. FDA’s MedWatch system dealing with psychiatric drugs causing violent side effects which have included 1,531 cases of homicidal ideation/homicide, 3,287 cases of mania and 8,219 cases of aggression. All along the FDA has admitted that less than 1 percent of side effects are reported to them. This all makes it shocking that psychiatrists and psychologists continue to nevertheless prescribe these poisons daily after making cursory unscientific diagnoses of people unfortunate enough to see them as patients. Clearly, these type of unethical professionals only care about the huge profits they earn with such conveyer belt unscrupulous practices which have been made legal by careless and incompetent lawmakers and judges.

Saturday, November 22, 2014

How do I file a complaint against a mental health care facility/professional?

As documented on the NAMI Website FAQ section

Complaints about an individual physician/psychiatrist:

If the physician/psychiatrist works for a hospital or agency, you may contact the doctor's supervisor. You can also file a complaint with the state medical board or the American Psychiatric Association (APA) (some psychiatrists are members, some are not). The APA might also refer you to its APA District Branch or state psychiatric society.

Complaints about other mental health professionals:

If employed by a hospital or agency, you may file complaints with the therapist's supervisor, the hospital ombudsman or the administrator. Therapists are regulated by their licensing boards (e.g. the state board of health and mental hygiene, counseling or other licensing board). They may also be members of their professional associations (such as the National Association of Social Workers, the American Psychological Association, etc.). Your NAMI State Organization may have the appropriate number and listing.

Abuse or neglect in an institutional setting:

Protection and Advocacy Agencies advocate on behalf of individuals with mental illness who are in institutional settings (such as jails, correctional facilities or state psychiatric hospitals); allegations of abuse or neglect are one of their top priorities.

Complaints of abuse, neglect or mistreatment in the hospital setting:

As mentioned above, you may file a complaint directly to the hospital ombudsman or administrator.

Or, you may contact The Joint Commission (formerly known as JCAHO, the Joint Commission on Accreditation of Healthcare Organizations) online or call their toll-free Compliant Hotline at (800) 994-6610 to share concerns regarding quality of care. The Joint Commission accredits hospitals, home health agencies, nursing homes, outpatient clinics, behavioral health care programs and managed care plans among others. Complaints should be related to patient rights, quality of care, safety, infection control, medication use and/or security. They are unable to assist with billing, insurance or payment disputes.

Complaints about a CMHC (community mental health center):

You may file a complaint with the state mental health agency. Medicaid and Medicare recipients with complaints about CMHCs have the following options: Medicare beneficiaries may contact the Centers for Medicare and Medicaid Services (CMS) regional Medicaid Service and the state Peer Review Organization. Medicaid beneficiaries may contact the state Medicaid official, and perhaps the state medical review board could help.

Friday, November 21, 2014

What’s Behind the Dramatic Decline in ECT Treatment Over the Past 15 Years?

As Reported in the Psychiatric News.

Here are some of the highlights:

There has been a dramatic decline in the use of electroconvulsive therapy in U.S. general hospitals over the past 15 years. [...] This finding comes from a study published online October 10 in Biological Psychiatry. The lead researcher was Brady Case, M.D., an assistant professor of psychiatry at Brown University and director of the Health Services Research Program at Bradley Hospital in East Providence, R.I. The study conducted by Case and his colleagues appears to be the first study on the use of inpatient ECT in U.S. general hospitals since 1992. They examined trends in the use of ECT in a national hospital sample over a 17-year period from 1993 to 2009. The hospitals were nonfederal, short-term general or specialty hospitals, including both public and private facilities and academic medical centers. However, freestanding psychiatric hospitals were excluded. In their paper, Case and his coworkers referred to all of the analyzed hospitals as “general hospitals.” Here are several of their most salient findings:

The percentage of general hospitals conducting ECT decreased from 15 percent to 11 percent, and the percentage of hospitals with psychiatric units conducting ECT decreased from 55 percent to 35 percent.

The number of stays in general hospitals involving ECT rose from 1993 to 1995 from 13/100,000 residents to 16/100,000 residents, but then fell gradually after that, to 7/100,000 residents in 2009. This decline appeared to be due, to a large extent, to reduced use of ECT with elderly patients, a group traditionally thought to benefit most from it. (?!!)

For inpatients with severe recurrent depression, the percentage whose treating hospitals conducted ECT fell from 71 percent to 45 percent.

Throughout the study period, depressed inpatients from poor neighborhoods and those who were publicly insured or uninsured were less likely to receive care from hospitals conducting ECT.

“The data strongly support the impression that psychiatric units of general hospitals are ceasing to conduct ECT and that this is driving the decline in the number of patients receiving ECT,” Case told Psychiatric News. But why are hospitals dropping the procedure? Possible explanations, Case said, are “growing pressures to avoid the inpatient treatment costs and length of stay associated with ECT and declining familiarity and more negative attitudes toward the procedure among providers and patients…. We didn’t have information on provider and patient attitudes, but as more facilities cease conducting ECT, we can expect that fewer clinicians and inpatients will be exposed to the option…. On the other hand, it is clear that popular perceptions of mental illness are increasingly biological, and where ECT is conducted, there has been no decline in patients electing to receive it.” [...] The findings have widespread implications, Case believes. For example, “most Americans admitted to general hospitals for severe, recurrent depression are now being treated in facilities that do not conduct ECT. This is the consequence of a solid 15-year trend in which psychiatric units appear to be discontinuing use of the procedure…. If the trends of the last 15 years hold, the number and proportion of general hospital psychiatric units conducting ECT will continue to decline, and fewer people will receive it.” He added that regulations expected to be issued by the FDA will influence how ECT is used in the future, “but as far as I know, the decision about how to classify ECT devices is still pending. If the FDA follows its panel recommendation and ultimately retains Class III—high risk—status for ECT devices, then I would expect the decline to accelerate.” [...]

Psychiatry In Decline: 55% of psychiatrists are over 55 and getting close to retirement age.

I stumbled across this article from a couple of years ago just recently, and wanted to share this snippet

While 37.6% of practicing physicians are age 55 or older, in psychiatry nearly 55% are in this age range, ranking as the second oldest group of physicians, surpassed only by preventive medicine. Part of this aging cohort effect is the low rate of medical school graduates choosing psychiatry. Only 4% of US medical school seniors (n = 698) applied for one of the 1097 post-graduate year one training positions in psychiatry. As Dr. Roberts noted, it is troubling that the area of medicine addressing the leading source of medical disability is also facing a shortage of new talent. Indeed, over the past decade the number of psychiatry training programs has fallen (from 186 to 181) and the number of graduates has dropped from 1,142 in 2000 to 985 in 2008. In spite of the national shortage of psychiatrists, especially child psychiatrists, 16 residency training programs did not fill with either U.S. or foreign medical graduates in 2011. Beyond these numbers, the profession is struggling with its identity, a theme echoed in other plenary talks at the APA meeting. Traditionally, psychiatry has been the medical discipline that cultivates a rich relationship with patients, countering suffering with empathy and understanding. But a recent article in the New York Times reported that only 11% of psychiatrists perform psychotherapy and described a psychiatrist who ran his office “like a bus station,” seeing so many patients for 5 -10 minute medication checks that he had to train himself not to listen to his patient’s problems.

ref:New York Times, March 5, 2011, “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy”

Half of psychiatrists do not take insurance

As seen in this report

We found that almost half of psychiatrists take don't take health insurance – whether it's private health insurance, Medicare (insurance for the elderly), or Medicaid (insurance for the poor). Specifically, we found that in 2009 to 2010, only 55% of psychiatrists took private health insurance, 55% took Medicare and 43% took Medicaid. This presents a significant barrier for patients who need to see psychiatrists. It's important to emphasize that this was a sharp contrast to every other type of doctor. For example, 94% of cardiologists took private health insurance during that same time period and 95% of general internists took Medicare. When pooled together, 88% of physicians all specialties other than psychiatry took private health insurance and 86% took Medicare. Acceptance rates for Medicaid were low overall because reimbursement rates are low. Nevertheless, psychiatrists had some of the lowest Medicaid acceptance rates of all specialties. The results shocked us and when our study was published last year, we learned that the results also shocked the general public. Doctors, patients and reporters corroborated our findings. I started to hear more and more stories of patients who struggled to find a psychiatrist who took their insurance.

LINK to Study in JAMA

Thursday, November 20, 2014

Psychiatric patient awarded $40,000 after sexual assault at Seven Oaks Hospital in Manitoba

From this report from CBC news

A former unit clerk at Seven Oaks Hospital has been ordered to pay a patient $40,000 in damages after an investigation found the clerk sexually interfered with her. According to court documents, in December of 2010 the woman, who is now 42, had a panic attack and was admitted to the psychiatric ward at Seven Oaks. She was diagnosed with bipolar disorder and was being treated for anxiety, depression and alcoholism. Within days of being admitted, she loaned a DVD to a male unit clerk. The man returned the DVD to her with his number enclosed. She says he openly read her medical files and another patient told her she thought the clerk was flirting with her. A few days later, the clerk smuggled a cell phone onto the ward for the woman. A statement filed by the woman claims he began texting her sexually provocative messages. He also told her that he loved her and would "always be there for her." On one occasion he followed her into her room and they kissed. They also met in his vehicle parked outside the hospital for a rendezvous. She applied for a day pass and he drove her to a liquor store and a hotel. Once inside a rented room, they drank large amounts of alcohol and had sex. The next weekend she applied for another pass and they checked in to a CanadInns Hotel and drank large amounts of alcohol. The following Monday, the patient checked herself out of hospital and the unit clerk stopped texting her and returning her calls. On December 24th, she received a phone call from the man's common-law wife asking her to stop contacting him. The woman says she didn't know the clerk had a partner. As the woman's condition improved, she realized what had happened and believed her judgment was impaired and the clerk took advantage of her. A provincial investigation report filed in November of 2011 found that the patient was vulnerable at the time of admission to the facility. It states: "There is evidence that the patient was subjected to sexual abuse by the respondent who was a staff member during her hospitalization and that this abuse caused the patient harm." The investigation report directs Seven Oaks to "develop and implement an educational strategy for professional boundaries and include all direct care staff who work with psychiatric patients." Since the incident the woman says she has had bouts of anxiety and depression, suffered from post traumatic stress disorder and had suicidal thoughts. She also says she is now afraid of being admitted to hospital. Lawyers for the woman have entered into an agreement with Seven Oaks to discontinue the claim against the hospital citing the hospital had minimal liability. The Winnipeg Regional Health Authority (WRHA) and Seven Oaks Hospital "take the safety and security of its patients very seriously, and are aware of the case." In a statement the WRHA said when the hospital was alerted by the patient, "Seven Oaks acted immediately by suspending the employee and notifying the Protection for Persons in Care Office (PPCO). Seven Oaks also conducted an investigation which resulted in the employee immediately being placed on leave as of February 16, 2011. As well, the hospital took steps to provide additional training and awareness to program staff about the importance and legal requirement to observe professional boundaries. This training is mandatory and provided annually."

Belgian psychiatrist Walter Vandereycken deregistered (lost his license) over sexual abuse

As seen in this report from BioEdge, a weekly newsletter about cutting-edge bioethical issues.

A Belgian psychiatrist who sexually abused a patient who subsequently sought euthanasia has been deregistered. Walter Vandereycken’s offences surfaced in 2012 when Ann G, a woman with anorexia nervosa, accused him on Terzake, a well-known current affairs program. He was suspended from his position as a professor at the Catholic University of Leuven (KULeuven), but continued in private practice. Now he has been suspended for life from the medical profession. (See original report in BioEdge.) Vandereycken, who is now 65, was no ordinary psychiatrist. Apart from being a sexologist, he was an international expert on anorexia (with a textbook published in English). Apparently he had been abusing patients for years; colleagues suspected, but no one blew the whistle. When Ann G appeared on Terzake, she had apparently already requested euthanasia. Going public gave her a brief respite from "the cancer in her head". However, she was bitterly disappointed that the man who had victimised her had not been severely disciplined. Then, overseen by a kindly new psychiatrist, she exercised her option. Oddly enough, none of the newspaper reports mentioned her death.

Terzake is a Dutch sews and current affairs TV magazine, presented by Lieven Verstraete or Annelies Beck.

Family of man who harmed himself to appeal in malpractice suit against the Vancouver Island Health Authority, an emergency-room physician and psychiatric nurse.

From a report in the Times Colonist

An appeal has been filed by a man and his family who lost a malpractice lawsuit against the Vancouver Island Health Authority, an emergency-room physician and psychiatric nurse. Joseph Briante, represented by his mother, Carol Briante, had filed the malpractice suit alleging that a psychiatric nurse and emergency-room doctor who saw Briante failed in their psychiatric assessment and treatment. Briante was a lawyer whose life began to spiral downward in the summer of 2007. By October, his mental health was deteriorating rapidly. On Oct. 29, 2007, he became delusional and paranoid, and feared being monitored, sacrificed or killed, his family said in court documents. His family rushed him to Royal Jubilee Hospital’s psychiatric emergency service. They arrived at 4:50 p.m. and Briante told the triage nurse he felt as if he was having a nervous breakdown. Briante was discharged at 7:30 that night without seeing the on-call psychiatrist. He was referred to outpatient counselling. In a psychotic state six days later, he slashed and stabbed himself in the neck and arm with a knife, resulting in severe blood loss and cognitive impairment. He is now unable to live independently. [...] Briante’s family — mother Carol, father James and brother-in-law Carter Hovey — have asked the court of appeal to find that the negligence was the cause of Briante’s injuries and therefore the cause of the expense of caring for Briante and the harm the family endured. That harm includes the psychological injury and trauma Briante’s family members experienced when the father and Hovey tried to hold him down while his mother attempted to administer mouth-to-mouth resuscitation.

Wednesday, November 19, 2014

Psychiatrists and Psychologists Are Not Reliable Expert Witnesses

As seen in this paper

(Abstract) Psychologists and psychiatrists serving as expert witnesses in court: what do they know about eyewitness memory?

(Melindera, Annika & Magnussena, Svein. Psychology, Crime and Law. Volume 21, Issue 1, 2015. DOI: 10.1080/1068316X.2014.915324)

Abstract Expert witnesses have various tasks that frequently include issues of memory. We tested if expert witnesses outperform other practitioners on memory issues of high relevance to clinical practice. We surveyed psychiatrists and psychologists who reported serving as expert witnesses in court (n = 117) about their knowledge and beliefs about human memory. The results were compared to a sample of psychiatrists and psychologists who had never served as expert witnesses (n = 819). Contrary to our expectations, the professionals serving as expert witnesses did not outperform the practitioners who never served. A substantial minority of the respondents harbored scientifically unproven ideas of human memory on issues such as the memory of small children, repression of adult traumatic memories, and recovered traumatic childhood memories. We conclude that the expert witnesses are at risk of offering bad recommendations to the court in trials where reliability of eyewitness memory is at stake.

And as seen on the Mad in America Website

Psychiatrists and psychologists who work as expert witnesses for the courts are generally no more scientifically knowledgeable or accurate about issues that involve human memory than regular practitioners or lay persons, according to a study published in Psychology, Crime and Law. In some court cases, wrote the authors of the study, the results could be “catastrophic”. The study was based on a questionnaire distributed to members of the Norwegian Psychological and Psychiatric Associations, to which about 940 professionals responded. The surveys asked questions about current scientific understandings with respect to psychological topics often relevant to court cases, especially involving factors that affect memories in victims or eyewitnesses. “The results of the present paper show that psychologists and psychiatrists serving as expert witnesses in court have limited knowledge about factors affecting the memory of eye witnesses and memory factors in general, and they do not score above the level of psychologists/psychiatrists in general,” wrote the authors. “Moreover, a comparison with the results of samples of lay persons and judicial professional shows that they do not outperform these samples on items common to the two surveys.” They described the overall performance of those professionals who said they’d served as expert court witnesses as “not very impressive.” At the same time, these professionals rarely indicated that they were “uncertain” about their responses.

Tuesday, November 18, 2014

Healthcare Serial Killings

As seen in this longer article by Joyce Frieden, News Editor, MedPage Today

Healthcare Serial Killings The number of serial killings committed by healthcare providers has leveled off in the U.S. in recent decades, although it is rising internationally, Eindra Khin Khin, MD, said in Chicago at the annual meeting of the American Academy of Psychiatry and the Law. According to the literature, the number of cases of healthcare serial killings overall rose from 10 in the 1970s to 21 in the 1980s, 23 in the 1990s, and then to 40 in the years 2000 to 2006, said Khin Khin, who along with her colleagues presented a poster on the topic. One reason the rates of healthcare serial murders are rising internationally, but not in the U.S., is electronic medical records (EMR), Khin Khin, of George Washington University in Washington, told MedPage Today in a phone interview. She noted that several serial killers, including physician Michael Swango, first got into trouble in the U.S. and then went overseas. "We know that in America, with the implementation of the EMR system, that really decreases the potential for these incidents," she said. "You can't just take out medications and start injecting someone; everyone's accountable because of EMR. But in most parts of world, they don't even have EMR." "At least in the [United] States, because of incidents in 1990s and 2000s, we've really beefed up on the credentialing system, and institutions have started to communicate with each other better," she continued. "People are not shedding enough light on the international phenomenon, and the global community has a little bit to catch up on in implementing guidelines and regulatory measures." In terms of the site, the vast majority of killings (72%) occurred in a hospital, with the remainder occurring in nursing homes (20%), patients' homes (6%) and outpatient settings (2%). Among the killings occurring in hospitals, the biggest percentage (38%) were committed on medical/surgical units, followed by the intensive care and critical care units (18%); the rest were spread among other wards including geriatrics, pediatrics, psychiatry, neurology, and the emergency department. As to the method used, the majority of killings -- 52% -- were done via lethal injection, followed by unknown methods (25%), suffocation (11%), and water in the lungs (4%). Air embolus and oral medications were each used in another 3%, while equipment tampering and poisoning accounted for 1% each. Among the drugs used were opiates and opioids (23%), potassium chloride (17%), insulin (13%), and other neuromuscular-blocking drugs (9%). More than half of killers (60%) were RNs, followed by aides (18%), physicians (12%), and non-RNs (8%). Healthcare serial killers have a variety of motivations, according to Khin Khin, including:

"Visionary": This rare type of serial killer is psychotic and kills in response to visions. For example, serial killer Herbert Mullin slaughtered 13 people because he thought he was preventing California from suffering an earthquake, she said.

"Missionary": These killers are trying to rid the world of people they see as "immoral or unworthy," Khin Khin said. One example is Thomas Cream, a physician in late 1800s England who killed the prostitutes who came to him for abortions.

"Thrill-Seeker": These people get a "high" from killing and are very sadistic.

"Lust Killer": These killers -- Swango is a good example -- get sexual pleasure from murder.

"Power/Control-Oriented Killer": These people kill to gain and exert power over their victims; they may have a sexual tone but they are not motivated by lust, said Khin Khin. Physician Harold Shipman is an example of this type of killer.

"Gain-Motivated": This group kills for psychological or tangible gain, which may come in the form of relieving a burden or in monetary profit. This can also take the form of Munchausen by proxy, such as the case of Richard Angelo, a nurse who injected patients with medications to paralyze their respiratory muscle, causing the patients to code. "When the code happened, he'd perform very well and colleagues would praise him, and he really liked that so he kept on doing it," she said.

Healthcare professionals who are concerned about a co-worker who might be involved in such activity can watch for certain "red flags," according to Khin Khin, including:

Unexpected deaths given patients' illnesses

A higher death rate with the suspect on duty

Multiple deaths in which the suspect is the last one seen with the victims

A suspect who is overly interested in death and dying

A suspect who is always available to "help"

A suspect who frequently moves from one facility to another

A suspect who has falsified information in the past

The researchers recommended several steps for preventing healthcare serial killings, such as educating staff members on the issue, designating a national or international regulation and monitoring body, routine institutional monitoring of high-alert medication use and monthly morality/cardiac arrest rates, and consensus guidelines for managing suspicious situations.

Unaddressed are the psychiatrists who do not kill, but instead who are content to cripple and crush the lives of their patients.

NYPD psychiatrist shot husband to start life with new lover, lawsuit claims

Snippet from a report in the New York Post

An NYPD shrink — whose job is to screen new recruits — put a bullet in her husband’s head as he slept so she could start a new life with her married lover, the wounded spouse claims in a lawsuit. Real estate developer Kenneth Dearden Jr. accused his wife, Emily, of shooting him execution-style with an antique derringer because she “had been having an on-and-off extramarital affair since at least early 2011.” Her lover, a Texas man named Warren Roudebush, ended his own marriage shortly before the November 2013 shooting and was pressuring Emily to do the same “so that they could be together,” according to the court papers filed last week in White Plains. “With [Kenneth] no longer in the picture, [Emily] could avoid a contentious divorce, keep the marital home and never admit the marriage infidelity to any family and friends,” the suit says. No one has been charged in the shooting inside the sprawling, Spanish colonial-style home that Kenneth and Emily share with their two young daughters in a posh section of Yonkers. Yonkers police Lt. Patrick McCormack called it a “complex case” and declined to comment on Kenneth’s allegations. The bullet that struck Kenneth entered at the back of his neck, near the base of his skull, passed underneath his ear canal and lodged in his left cheek. He survided the shooting following surgeries to remove the bullet and to repair a severed artery to his brain.

Monday, November 17, 2014

U.S. Psychology Licensing Boards by State (Updated Listing)

Here is a list of Psychology Licensing Boards in the USA, given Alphabetically by State

This is contact information for state and territorial agencies responsible for the licensing and certification of psychologists throughout the U.S. listed in alphabetical order below

Please note that while we think this information is correct, that names and telephone numbers may have changed. This information may be useful if you want to file a complaint against your local psychologist.

ALABAMA
Alabama Board of Examiners of Psychologists
Address
660 Adams Ave.
Suite 360Montgomery, Alabama 36104
Phone

(334) 242-4127

Friday, November 28, 2014

Thursday, November 27, 2014

Wednesday, November 26, 2014

Tuesday, November 25, 2014

"Protective factor"

"The jury was offended"

Monday, November 24, 2014

Sunday, November 23, 2014

Saturday, November 22, 2014

Complaints about an individual physician/psychiatrist:

Complaints about other mental health professionals:

Abuse or neglect in an institutional setting:

Complaints of abuse, neglect or mistreatment in the hospital setting:

Complaints about a CMHC (community mental health center):

Friday, November 21, 2014

Thursday, November 20, 2014

Wednesday, November 19, 2014

Tuesday, November 18, 2014

Monday, November 17, 2014

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