Donald Lee-Edwards was arrested this week and accused of impersonating a clinical psychologist and medical doctor for three years and potentially providing mental health services to over 100 patients, said the Richmond County District Attorney’s office. He is “a dangerous scam artist who never completed any medical school or doctoral program. He merely bestowed upon himself the professional titles of clinical psychologist and medical doctor,” said Daniel Master Jr., Richmond County district attorney.
According to authorities, Lee-Edwards said he worked “extensively with family members and victims of 9/11” and made himself available for home visits. In June, the district attorney’s office was notified of his practice after skeptical patients complained of his unorthodox bedside manner and his prescription methods. CNN affiliate WCBS spoke to one of Lee-Edwards’ patients, Kim Broadie, outside his office. Broadie showed them a bottle of anti-depressants he had been prescribed with a different doctor’s name; the district attorney’s office said Lee-Edwards would call in his prescriptions under the identity of a different doctor with a similar sounding name.
Lee-Edwards operated out of a basement apartment below a two-family residence in Staten Island; he lived in the floor above his office with his parents, officials said.
Photographs released by the district attorney’s office show a waiting room with seating area, a kitchenette, a front desk and rooms for treatment. They also show shelves of blood vials and urine samples and medical equipment throughout the apartment.
Lee-Edwards’ letterhead advertised him as a clinical psychologist, Ph.D., M.D. and L.P., and when CNN called Lee’s business and cell phone numbers for comment, his voice mail did the same. Lee-Edwards and his attorney, Matthew Blum, could not be reached for comment. The district attorney’s office said during Lee-Edwards’ time practicing, he saw “approximately 10 parolees through word-of mouth referrals” and he would talk to their parole officers about session attendance. He also prepared progress reports for parolee’s files, officials said.
The district attorney’s office brought a 12-count indictment against Lee-Edwards, including charges of criminal impersonation, identity theft, unauthorized practice of medicine, criminal diversion of prescription medications and prescriptions. Lee-Edwards is due back in court in September and is being held on a $150,000 bond/$75,000 bail.
Saturday, August 15, 2015
New York man charged with impersonating doctor, potentially providing mental health services to over 100 patients over a three year old.
Thursday, August 13, 2015
The “Institutional Corruption” of Psychiatry: A Conversation with Authors of Psychiatry Under the Influence
Bruce Levine: Psychiatry Under the Influence attempts to understand psychiatry’s denial and refusal to accept blame for its failures. So, for example, Ronald Pies, editor-in-chief of Psychiatric Times, refuses to blame psychiatry for the dissemination of the disproven chemical imbalance theory of mental illness (which fueled the dramatic rise of antidepressant use). Pies claims that the chemical imbalance theory “was always a kind of urban legend—never seriously propounded by well-informed psychiatrists,” and he blames Americans’ widespread belief in it on drug companies. You attribute much of psychiatry’s denial and evasion of responsibility to “cognitive dissonance theory”—can you speak about this?Worth the read
Robert Whitaker: Again, this is part of the “institutional corruption” lens we were using to study the institution of psychiatry and its behavior. The assumption is that individuals within the institution can’t see that their behavior has been corrupted by “economies of influence.” And so, when those outside the institution begin pointing out the corruption in it, those within it may construct a narrative that protects their self-image. In this case, psychiatrists need to protect their image as honest researchers and as physicians who put the interests of their patients first. Cognitive dissonance theory reveals that there are a myriad of ways that people protect themselves in this manner.
We can see that cognitive dissonance quite clearly in Ronald Pies’ claim that the “chemical imbalance” theory was always a kind of urban legend. The fact that psychiatrists, for a long period of time, regularly told patients that the drugs fix chemical imbalances in the brain represented a fundamental betrayal of those patients. So once the chemical imbalance story fell apart publicly, what does Pies do? Does he admit, even in his own mind, that psychiatrists told this false story to patients for decades? No, he says well-informed psychiatrists never said it, and places the blame on the pharmaceutical companies for telling that false story. Pies makes this argument even though it is easy to document that the leaders of the APA often told this chemical imbalance story to the public, and that, even today, many prominent psychiatrists serve on advisory boards of patient advocacy groups that continue to tell it to the public.
Lisa Cosgrove: One of my favorite quotes is by Carol Tavris: “Mistakes were made, but not by me.” None of us are immune to cognitive dissonance. It is part of the human condition to have implicit biases and remain blissfully ignorant of them.
Saturday, August 08, 2015
A VA doctor was arrested in Danville Thursday morning for reckless homicide charges filed by prosecutors in Indiana.
The criminal counts announced Friday by the Marion County prosecutor's office charge that Dr. John Sturman overprescribed narcotics for pain that resulted in the deaths. The patients died in 2010 and 2011, but aren't identified in court records.
Danville police confirmed today that Sturman was a doctor at the Veterans Affairs Illiana Health Care System and was arrested on the warrant at the VA. According to U.S. News and World Report, Sturman was a neurologist in Danville at the Veterans Affairs Illiana Health Care System. He has been in practice for 44 years.
The prosecutor's office says Sturman was jailed in Danville, Illinois, pending extradition to Indianapolis. It wasn't immediately clear whether Sturman has an attorney.
The prosecutor's office says Sturman operated a clinic at Indiana University Hospital in Indianapolis, but lost his admitting privileges in 2012 after he failed to complete medical charting and documentation of patient visits.
Sturman also faces 16 counts of improperly prescribing drugs.
Wednesday, August 05, 2015
My son died in a mental health facility. If we keep protecting dangerous hospitals, he won’t be the last.
From the Washington Post. Full article at the link
On Nov. 23, I received the call no parent wants to get – my only son was dead. My beautiful, 24-year-old boy was gone. It is a nightmare I have yet to wake up from; one I will never wake up from.Of course, the problem is that these people are trusted to do things the are not capable of doing.
I could barely hear the words from the other end of the line; my cries were drowning them out. I was driving when I received the call, and had to pull over to call my son’s father. Then I had to drive home to deliver the news to my daughter, Paris. How I made it home without getting in a wreck is a mystery to me.
Two-and-a-half months prior, my ex-husband, Kristoff St. John, and I had placed our son, Julian, at Telecare’s La Casa Mental Health Rehabilitation Center in Long Beach, Calif. on a 72-hour involuntary psychiatric hold. Julian had been diagnosed with paranoid schizophrenia when he was 17 and had become suicidal while off his medication and on a powerful substance – meth. The staff upgraded him to a 14-day hold, and then lengthened it again for an indefinite period, to give him adequate time to get off of meth.
Like many parents of children with mental health issues, our goal was to find help for our son who suffers from a horrific illness for which there is no cure. We knew that, with proper medication and therapy, Julian had a chance of living a comfortable life. So we sought help from Los Angeles County’s Department of Mental Health, which referred us to Telecare’s facility. The county says it pays Telecare $17 million per year to contract 190 beds at La Casa. We had hoped that the facility would help him withdraw from meth and get back on his meds, and that within the year, Julian would come home – alive.
But we made a fatal mistake placing our son in the care of La Casa, one of many mental health facilities in this country that contracts with state and local governments. Like many before him, Julian didn’t make it out alive.
Monday, August 03, 2015
A doctor who described himself in an Orange County Register investigation as the “guru” of mood-stabilizing drugs has been put on probation for the second time by state medical regulators.
The Medical Board of California put Laguna Niguel physician Paul Corona on a five-year probation Friday for gross negligence in treating five patients and failing to maintain adequate medical records. He was also put on probation in 2009 after suffering a psychotic breakdown.
Corona, who described himself to the Register as the most prolific prescriber of mood-stabilizing drugs anywhere, is prohibited from supervising physician assistants during his probation.
Jodi Barber, whose son, Jarrod, overdosed in 2010 on a mixture of drugs, some prescribed by Corona, said the state was too lenient. “This is ridiculous. Remove his license permanently. How many slaps on the hand is he going to be given?” said Barber of Laguna Niguel. Her son did not appear to be one of the victims in the state complaint.
Corona was the subject of a 2011 investigation by the Register into how doctors overprescribed to teens, fueling a rise in Orange County overdoses. Coroner records show accidental fatal overdoses have risen steadily from 130 in 2003 to 291 in 2013. Corona preached the use of psychotropic drugs to remove the mental traumas that feed drug addiction.
“I am the top prescriber of psychotropic medications around,” Corona said. “Ninety-five percent of my patients are very happy.”
But drug addiction experts questioned Corona’s tactics, saying it didn’t make sense to use drugs to fight drugs. Dr. Harry Haroutunian, physician director at the famed Betty Ford Center in Rancho Mirage, told the Register in 2011 it is especially dangerous to prescribe drugs with sedative qualities when treating addicts in an outpatient setting, where they might score more drugs on the street.
“If he is telling you he is the highest prescriber,” Haroutunian said, “that would be a dubious distinction by my measuring stick.”
Corona first came under the state’s attention after Orange County sheriff’s deputies were sent to his Laguna Niguel home in 2007 to investigate reports of a man having a psychotic breakdown and threatening suicide, according to a medical board accusation.
“Respondent was acting bizarre and was very aggressive, yelling and screaming incoherently. The officers had to taser respondent several times in order to subdue him,” said the report by the medical board. Corona was hospitalized for nearly a month for psychological observation.
It was the same year that he published a book about treating mood disorders, entitled “Healing the Mind and Body.” In a 2008 interview with the medical board, Corona said he suffered an episode of hypomania three years prior. State documents say that he was prescribed Seroquel by his psychiatrist, but he admitted to self-medicating from his sample drugs after his psychiatrist moved away.
“His disorder has impacted his ability to practice safely and led to his hospitalization for a psychotic breakdown,” the state complaint said. He was put under suspension for five years in June 2009.
Under the latest probation, Corona must take courses in prescribing practices, medical record keeping, medical ethics and clinical education. He must also find another physician to monitor him, according to medical board documents.
Sunday, August 02, 2015
A Houston psychiatrist who was indicted separately in the Riverside General Hospital $160 million Medicare billing fraud scheme pleaded not guilty on Friday and intends to stand trial in August.
Dr. Sharon Iglehart is accused of one federal conspiracy count, two health care fraud charges and a pair of allegations that she made false statements to investigators. At a pretrial conference before U.S. District Judge Ewing Werlein, her lawyers - which include high-powered defense attorney Rusty Hardin - said she is ready to face a jury. Iglehart originally was arrested in December 2013, but the allegations have been amended twice since then - growing from nine to 12 pages in the most recent indictment secured from a federal grand jury and filed on July 21. Iglehart pleaded not guilty to the amended five counts and retained her freedom on $50,000 bail.
Former Riverside CEO and president Earnest Gibson III was convicted as the ringleader in three conspiracies involving Medicare billings for Riverside's psychiatric treatment programs from 2005 to 2012 in which patients were ineligible for treatment or were warehoused but did not receive the reported care. The government alleged that $31 million in fraudulent reimbursement requests were paid. His son, former group home owner Earnest Gibson IV was also convicted at trial and sentenced to 20 years.
The elder Gibson received the heaviest punishment so far: 45 years. His second-in-command, Mohammad Khan, received a 40-year sentence. They received some of the nation's longest sentences for health care fraud - particularly, stealing from the Medicare or Medicaid programs, which is one of the top criminal prosecutorial priorities for the U.S. Justice Department.
Through her Iglehart Wellness Center, the psychiatrist allegedly participated in the scheme by submitting claims that falsely indicated she provided intensive outpatient services for severe mental illness through Riverside's treatment program. Iglehart retains an active medical license in Texas. She was reprimanded by the Texas Medical Board in 2009 for "recreating medical records for psychiatric patients significantly later than the time she had provided examination, diagnosis and treatment to the patients," according to the agency's website. Her disciplinary status was cleared in 2011.
Jury selection in Iglehart's case is set for Aug. 31. If convicted, the doctor faces up to 10 years in prison on each count. Regina Askew, who rose from a case worker to become an auditor, will spend 12 years in prison.
In July, Sharonda Holmes, who was involved in paying and receiving kickbacks, was sentenced to 3½ years and Waddie McDuffie became the sixth person to receive prison time in the scam that crippled Riverside. The historic Third Ward institution began as Houston's first hospital for black patients and became one of the state's largest providers of substance abuse and mental health treatment. McDuffie pleaded guilty to delivering kickback money to group home owners in exchange for them sending patients for mental health treatment at the hospital. He received a five-year term of probation and six months of home confinement. Those who have pleaded guilty or were convicted at trial are among the dozen defendants who are jointly responsible for $46 million in restitution.
All of the Riverside cases are being prosecuted by Washington-based lawyers assigned to the Justice Department's criminal fraud division.
Friday, July 31, 2015
In a historic culmination to decades of “horrific” living conditions and a pattern of constitutional violations, the Miami-Dade County Jail in Florida has finally closed the “Forgotten Floor” – the notorious ninth floor at the facility that was used to house mentally ill prisoners, often for months and years at a time, with levels of care so abysmal that prisoners routinely died.
“It is thrilling on one level but kind of sad that it has taken so long,” said Miami-Dade Judge Steve Leifman of the December 23, 2014 closure of the jail’s ninth floor. “A lot of people have been hurt or died up there.” Leifman, as chair of the 11th Circuit Mental Health Project, has been a long-time advocate for the mentally ill.
In 2013 alone, three mentally ill prisoners housed on the ninth floor died. On August 26, Joseph Wilner, 59, was found “unresponsive” in his cell; jailed for driving on a suspended license, he was in the unit reserved for the most acute mental cases.
In July 2013, Leifman was informed of the death of wheelchair-bound prisoner Joaquin Cairo. An employee with the jail’s diversion program told the court that Cairo said “someone propositioned him while in custody and when [he] declined they threw him against the bed and against the floor.” Cairo suffered a broken pelvis and died from internal bleeding.
“The neglect was despicable. Despicable,” Leifman said. “He should have been taken to a hospital immediately, and there is absolutely no excuse.”
Three months earlier another psych ward patient, Juan Matos-Flores, who was considered a suicide risk, died after jailers found him unresponsive on the floor of his cell. When staff tried to call 911 they were unable to do so because the phones on the ninth floor were programmed to block outgoing calls. Instead, employees were forced to call another floor to get help.
“It’s a floor that is specifically designed for people who are ill. It’s absurd,” Leifman said after learning of the telephone debacle.
When the ninth floor at the Miami-Dade County Jail closed, some 400 prisoners were transferred to six newly-refurbished wings at the Turner Guilford Knight Correctional Center, where the telephones allow 911 calls and cameras monitor prisoners in every cell.
The Miami-Dade County Jail, the nation’s eighth-largest, has been under federal monitoring since the U.S. Department of Justice concluded a three-year investigation in 2011 that found a “pattern and practice in constitutional violations” of prisoners’ rights due to deplorable living conditions.
Leifman was more blunt, calling conditions on the Forgotten Floor “horrific.”
“It was not built to be a psychiatric facility. It was built as a jail [with a cell] for one person, and here two and three people [were placed] in there that are very psychotic,” he said.
The public got its first glimpse of the infamous floor in 2006 when Leifman invited a television reporter and camera crew to document conditions as he guided a tour. “Human beings should not be treated like this. No blankets, no beds, no mattresses. We sleep on the floor,” one prisoner told CBS4 chief investigative reporter Michele Gillen, who found the faucets in cells were not working and prisoners were drinking water from the toilets. Leifman credited Gillen’s reporting with stirring public outrage which, in turn, prompted action.
“We have finally closed the ninth floor, thanks to you,” Leifman told Gillen in an interview. “I don’t think the public ever would have understood how horrendous the situation was, but for your reporting. And it led to where we are today.”
Thursday, July 30, 2015
Anchorage Doctor Sentenced to 3 ½ years for Fraudulently Billing Medicaid and Tampering with Physical Evidence
The Alaska Department of Law, Medicaid Fraud Control Unit, announced today that 40-year-old Dr. Shubhranjan Ghosh was sentenced to 3 ½ years of active incarceration. Dr. Ghosh pled guilty to Medical Assistance Fraud and Tampering With Physical Evidence, which he committed between 2010 and 2013 at his practice, Ghosh Psychiatric Services.The information filed in the Ghosh complaint can be found on the MFCU website.
Judge Philip Volland also ordered Dr. Ghosh to repay $605,000 in restitution to Medicaid. After release, Dr. Ghosh will be on probation for 10 years, and there will be 3 ½ years jail time that the Court could impose if he violates probation. Dr. Ghosh was remanded to custody at sentencing today. The Medical Board will decide the future of Dr. Ghosh’s medical license.
In court papers, Assistant Attorney General Jonas Walker argued that Dr. Ghosh “is a con artist who happens to hold a medical license.” The State presented evidence at sentencing, including a video showing Dr. Ghosh urging an employee to sign false affidavits stating that medical services were provided when, in fact, they were not.
Judge Volland remarked the community should be “shocked” by Dr. Ghosh’s “unconscionable and unacceptable” crimes of “poaching” money from a program designed to provide medical care to a particularly vulnerable population.
The case was initiated by citizen complaint and jointly investigated by the Alaska Department of Law, Alaska State Troopers, Anchorage Police Department, Alaska Department of Health and Social Services, the U.S. Department of Health and Human Services, Office of Inspector General, Federal Bureau of Investigation, Immigration and Customs Enforcement Homeland Security Investigations. Mr. Walker emphasized that this case is a great example of how state and federal collaboration can work to combat fraud and abuse in the Medicaid system.
The Alaska MFCU is part of the Attorney General’s Office. The MFCU is responsible for investigating and prosecuting Medicaid fraud and abuse, neglect or financial exploitations of patients in any facility that accepts Medicaid funds.
Saturday, July 25, 2015
Federal regulators are taking the rare step of kicking one of North Texas’ largest psychiatric hospitals out of the Medicare and Medicaid programs for leaving patients in “immediate jeopardy” of injury or death.Much more information at the link, which includes hand wringing over what they will do when a dangerous and unsafe facility is shut down.
Timberlawn flunked a make-or-break inspection, a final chance to prove it could fix an array of problems after promising improvements for months.
The U.S. Centers for Medicare & Medicaid Services found that unlicensed personnel were monitoring patients and some patients were going more than 12 hours without seeing a nurse. Electrical cords and other unsafe objects remained in rooms within reach of suicidal patients.
“These practices posed an immediate jeopardy to the health and safety of patients,” inspectors said in a report.
The state said it is moving quickly to evaluate its enforcement options.
“The issues have been egregious and incredibly disheartening. We are absolutely looking at the full range of penalties, including license revocation,” said Carrie Williams, a spokeswoman for the Texas Department of State Health Services. “Our inspectors have been in and out of the facility since February, citing issues and not seeing progress. It’s turned into a critical situation.”
Wednesday, July 22, 2015
Photo caption:Lehigh Valley Community Mental Health Centers Inc. at 226 Northampton St., Easton, is seen July 20, 2015. It is one of 10 mental health clinics sued July 20, 2015, by the U.S. Attorney's Office for the Eastern District of Pennsylvania, along with owner Melissa Chlebowski and Melchor Martinez. Martinez is alleged to have run the Medicare- and Medicaid-funded clinics in Easton, Bethlehem, Allentown, Philadelphia and Raleigh, North Carolina, despite a 2000 ruling excluding him from participating in these and any federally funded health care programs.
Director Allison E. Frantz said the department received complaints about the delivery of care at Lehigh Valley Community Mental Health Centers Inc., now the target of a federal whistleblower lawsuit. The department forwarded the complaints, prompting an investigation, she said.
"The Northampton County DHS has taken steps to ensure the county's citizens' behavioral health treatment would not be jeopardized: the provider network was enhanced to include additional bi-cultural, bilingual treatment professionals and regular and frequent on-site clinical reviews, including additional billing audits," Frantz wrote in an email Tuesday.
After the U.S. Attorney's Office for the Eastern District of Pennsylvania announced the lawsuit Monday, patients were left with myriad questions about the care they had received and whether the five local centers in Easton, Bethlehem and Allentown would remain open.
The suit also targets the centers' owner, Melissa Chlebowski, and her husband, Melchor Martinez, both of Allentown, as well as four sister mental health centers in Philadelphia and one in North Carolina.
The suit alleges the mental health clinics used unqualified stand-ins for psychiatrists and rushed patients through "medication management" visits. Federal prosecutors also say the centers were really run by Martinez, despite being prohibited since 2000 from participating in Medicaid, Medicare or any federally funded health care programs.
The civil action seeks damages and penalties.
Tuesday, July 21, 2015
Taken from the much larger article which is a book review of "Active Shooters and Psychotropic Drugs SSRI’s" by Chris Grollnek and Chris Magee. Without quoting the full review, all we really need to is to cite this list of deaths and "the coincidence" of all these shooting associated with psychiatric drugs.
- Eric Harris age 17 (first on Zoloft then Luvox) and Dylan Klebold aged 18 (Columbine school shooting in Littleton, Colorado), killed 12 students and 1 teacher, and wounded 23 others, before killing themselves. Klebold’s medical records have never been made available to the public.
- Jeff Weise, age 16, had been prescribed 60 mg/day of Prozac (three times the average starting dose for adults!) when he shot his grandfather, his grandfather’s girlfriend and many fellow students at Red Lake, Minnesota. He then shot himself. 10 dead, 12 wounded.
- Cory Baadsgaard, age 16, Wahluke (Washington state) High School, was on Paxil (which caused him to have hallucinations) when he took a rifle to his high school and held 23 classmates hostage. He has no memory of the event.
- Chris Fetters, age 13, killed his favorite aunt while taking Prozac.
- Christopher Pittman, age 12, murdered both his grandparents while taking Zoloft.
- Mathew Miller, age 13, hung himself in his bedroom closet after taking Zoloft for 6 days.
- Kip Kinkel, age 15, (on Prozac and Ritalin) shot his parents while they slept then went to school and opened fire killing 2 classmates and injuring 22 shortly after beginning Prozac treatment.
- Luke Woodham, age 16 (Prozac) killed his mother and then killed two students, wounding six others.
- A boy in Pocatello, ID (Zoloft) in 1998 had a Zoloft-induced seizure that caused an armed stand off at his school.
- Michael Carneal (Ritalin), age 14, opened fire on students at a high school prayer meeting in West Paducah, Kentucky. Three teenagers were killed, five others were wounded..
- A young man in Huntsville, Alabama (Ritalin) went psychotic chopping up his parents with an ax and also killing one sibling and almost murdering another.
- Andrew Golden, age 11, (Ritalin) and Mitchell Johnson, aged 14, (Ritalin) shot 15 people, killing four students, one teacher, and wounding 10 others.
- TJ Solomon, age 15, (Ritalin) high school student in Conyers, Georgia opened fire on and wounded six of his class mates.
- Rod Mathews, age 14, (Ritalin) beat a classmate to death with a bat.
- James Wilson, age 19, (various psychiatric drugs) from Breenwood, South Carolina, took a .22 caliber revolver into an elementary school killing two young girls, and wounding seven other children and two teachers.
- Elizabeth Bush, age 13, (Paxil) was responsible for a school shooting in Pennsylvania
- Jason Hoffman (Effexor and Celexa) – school shooting in El Cajon, California
- Jarred Viktor, age 15, (Paxil), after five days on Paxil he stabbed his grandmother 61 times.
- Chris Shanahan, age 15 (Paxil) in Rigby, ID who out of the blue killed a woman.
- Jeff Franklin (Prozac and Ritalin), Huntsville, AL, killed his parents as they came home from work using a sledge hammer, hatchet, butcher knife and mechanic’s file, then attacked his younger brothers and sister.
- Neal Furrow (Prozac) in LA Jewish school shooting reported to have been court-ordered to be on Prozac along with several other medications.
- Kevin Rider, age 14, was withdrawing from Prozac when he died from a gunshot wound to his head. Initially it was ruled a suicide, but two years later, the investigation into his death was opened as a possible homicide. The prime suspect, also age 14, had been taking Zoloft and other SSRI antidepressants.
- Alex Kim, age 13, hung himself shortly after his Lexapro prescription had been doubled.
- Diane Routhier was prescribed Welbutrin for gallstone problems. Six days later, after suffering many adverse effects of the drug, she shot herself.
- Billy Willkomm, an accomplished wrestler and a University of Florida student, was prescribed Prozac at the age of 17. His family found him dead of suicide – hanging from a tall ladder at the family’s Gulf Shore Boulevard home in July 2002.
- Kara Jaye Anne Fuller-Otter, age 12, was on Paxil when she hung herself from a hook in her closet. Kara’s parents said “…. the damn doctor wouldn’t take her off it and I asked him to when we went in on the second visit. I told him I thought she was having some sort of reaction to Paxil…”)
- Gareth Christian, Vancouver, age 18, was on Paxil when he committed suicide in 2002, (Gareth’s father could not accept his son’s death and killed himself.)
- Julie Woodward, age 17, was on Zoloft when she hung herself in her family’s detached garage.
- Matthew Miller was 13 when he saw a psychiatrist because he was having difficulty at school. The psychiatrist gave him samples of Zoloft. Seven days later his mother found him dead, hanging by a belt from a laundry hook in his closet.
- Kurt Danysh, age 18, and on Prozac, killed his father with a shotgun. He is now behind prison bars, and writes letters, trying to warn the world that SSRI drugs can kill.
- Woody __, age 37, committed suicide while in his 5th week of taking Zoloft. Shortly before his death his physician suggested doubling the dose of the drug. He had seen his physician only for insomnia. He had never been depressed, nor did he have any history of any mental illness symptoms.
- A boy from Houston, age 10, shot and killed his father after his Prozac dosage was increased.
- Hammad Memon, age 15, shot and killed a fellow middle school student. He had been diagnosed with ADHD and depression and was taking Zoloft and “other drugs for the conditions.”
- Matti Saari, a 22-year-old culinary student, shot and killed 9 students and a teacher, and wounded another student, before killing himself. Saari was taking an SSRI and a benzodiazapine.
- Steven Kazmierczak, age 27, shot and killed five people and wounded 21 others before killing himself in a Northern Illinois University auditorium. According to his girlfriend, he had recently been taking Prozac, Xanax and Ambien. Toxicology results showed that he still had trace amounts of Xanax in his system.
- Finnish gunman Pekka-Eric Auvinen, age 18, had been taking antidepressants before he killed eight people and wounded a dozen more at Jokela High School – then he committed suicide.
- Asa Coon from Cleveland, age 14, shot and wounded four before taking his own life. Court records show Coon was on Trazodone.
- Jon Romano, age 16, on medication for depression, fired a shotgun at a teacher in his New York high school.
Monday, July 20, 2015
The U.S. Attorney’s Office for the Eastern District of Pennsylvania filed a civil health care fraud lawsuit Monday, under the False Claims Act, against an Allentown husband and wife and their network of mental health centers funded largely by Medicaid and Medicare.
The lawsuit names Melchor Martinez and Melissa Chlebowski, both of Allentown, as defendants and their businesses: Northeast Community Mental Health Centers in Philadelphia; Lehigh Valley Community Mental Health Centers in Allentown, Easton and Bethlehem; and North Carolina Community Mental Health Centers in Raleigh, N.C.
The complaint notes Martinez was convicted of Medicaid fraud in 2000 and, as a result, was excluded from participating in all federally funded health care programs including Medicaid and Medicare. The exclusion prohibited Martinez from owning, managing or receiving payments from any federally funded health care provider.
The lawsuit alleges that in spite of the exclusion, Martinez, assisted by his wife Chlebowski, continued to own and operate the Northeast and Lehigh Valley clinics, and that, in 2009, while his exclusion was ongoing, he started up the North Carolina clinic in Raleigh.
The complaint also says the clinics billed Medicaid for psychiatrist visits “of very brief duration, sometimes as little as two to three minutes, while fraudulently representing that patients were being seen for a 15 minute visit.”
The Northeast and Lehigh Valley clinics allegedly billed Medicaid and Medicare for the services of “therapists” who were not qualified to provide mental health services, and fraudulently billed Medicare for therapy services allegedly provided without the required supervision.
The complaint did not specify the damages being sought by the government.
The matter was investigated by the U.S. Department of Health and Human Services’ Office of Inspector General and the U.S. Attorney’s Office for the Eastern District of Pennsylvania, with assistance from the Pennsylvania Office of Attorney General and the North Carolina Department of Justice.
Saturday, July 18, 2015
The Hoffman Report is the informal name for the 2015 investigation into the American Psychological Association’s (APA) practices regarding its relaxing of ethical standards for psychologists involved in torture interrogations. The full name for the report is, Independent Review Relating to APA Ethics Guidelines, National Security Interrogations, and Torture. It was authored by attorneys David Hoffman, Danielle Carter, Cara Viglucci Lopez, Heather Benzmiller, Ava Guo, Yasir Latifi and Daniel Craig of the law firm, Sidley Austin, LLP.
It was an extensive investigation spanning 6 months that reviewed over 50,000 documents and conducted over 200 interviews with 148 people.
The report notes that,
“Although most individuals were quite cooperative and willing to meet with us, that sentiment was not universal, and there were several individuals who declined to meet with us or did not respond to our requests.”
“This inquiry is made more difficult by the amount of time that has elapsed since the important events occurred. The key events relating to the APA task force report occurred 10 to 11 years ago, and the events relating to the ethics code revision occurred 13 to 19 years ago.”
The independent investigation resulted in a 542-page final report. It is available for download here
Independent Review Relating to APA Ethics Guidelines, National Security Interrogations, and Torture (PDF)
Thursday, July 16, 2015
From a Report on Fox 9 News Video available at the link
The University of Minnesota has another ethics scandal on its hands. And once again it involves the Department of Psychiatry. This latest case of research misconduct involves falsifying records.
Dr. Ken Winters is a Psychologist who has worked at the U of M for 26 years. He was about to begin a new study for the National Institute on Drug Abuse on ways to stop teenagers from taking drugs, but before proceeding, a University review board wanted Winters to get something in writing from the federal government.
It would have been a legal document that would protect researchers from having to disclose confidential information about study participants should those participants ever get into trouble with the law. Winters told the Fox 9 Investigators he got tired of waiting for the paperwork to arrive so he falsified his own version and turned it in to the University so the study could begin.
He declined an on camera interview but agreed to have his voice recorded.
"Poor judgement on my part," Winters said. "It was a terrible thing I did, so I have no real explanation. I've got no defense. My own stupidity, poor judgement."
Winters also said within hours of turning in the phony documents, he fessed up after being approached by concerned staff members. His misconduct is yet another slam for the school's Department of Psychiatry.
Earlier this spring, a legislative audit, prompted by a Fox 9 Investigation, found serious ethical concerns and conflicts of interest relating to the death of a research participant in a Psych Department drug trial.
"It is a serious ethical breach. It is another indication that there are issues and problems in the drug trials at the University Department of Psychiatry that need attention," Legislative Auditor Jim Nobles said.
The National Institute on Drug Abuse told the Fox 9 Investigators "it takes allegations of research misconduct seriously." But wouldn't comment on what, if anything, it’s doing about this case.
Winters said he hasn't been disciplined by the University for falsifying the document. Instead, he was given the option to retire at the end of the month.
Wednesday, July 15, 2015
An abrupt end for Houston psychiatric hospital Cambridge facility gives up license and discharges its last patient
One of Houston's largest inpatient psychiatric hospitals closed suddenly last week, leaving a void in a city already underserved.
The 148-bed facility at 7601 Fannin had operated as Cambridge Hospital since 2012. On Monday the phone was disconnected and its website contained only the stark message: Cambridge Hospital is closed. Attempts to reach officials at the facility were unsuccessful.
The hospital surrendered its state license on July 7 and discharged its last patient the same day, said Chris Van Deusen, a spokesman for the Texas Department of State Health Services.
Those in Houston's mental health community said the closing was not entirely unexpected.
"I was hearing that this was coming," said Steve Glazier, chief operating officer at Harris County Psychiatric Center, the area's largest facility with 250 beds. He said administrators acknowledged financial struggles to him more than a year ago.
Cambridge Hospital began operating in 2012 in the space that once housed IntraCare Medical Center, once the second-largest inpatient facility in the county.
IntraCare closed after losing its certification from the federal Centers for Medicare and Medicaid Services, which had declared it "an immediate and serious threat to patient health and safety."
Tuesday, July 14, 2015
The state has temporarily suspended the license for Dr. William Munn after the Medical Board of California said the psychiatrist, in private practice since 1972 at his Travis Boulevard office, put public health at risk by excessively prescribing drugs to five patients.
Munn disputes any risk to public health and says his suspension is detrimental to his 250 patients, who can’t be absorbed by the limited number of psychiatrists in private practice in Solano County.
The Monday suspension follows a hearing in Oakland and the filing by the state Attorney General’s Office about Munn’s prescriptions for the five patients.
Munn referred to providing one patient “telephone psychotherapy,” said the state filing, which describes the therapy as consisting almost entirely of the psychiatrist refilling prescriptions for large quantities of hydrocodone, a semisynthetic narcotic analgesic, as well as amphetamines and alprazolam, often sold under the trade name Xanax.
Another patient was prescribed large doses of alprazolam even though the doctor saw the person only once and continued to prescribe the drug for almost two years, according to the state.
Treatment of the five patients includes numerous extreme departures from the standard of care, added the state, which sought the license suspension until the Medical Board can ensure Mann safely practices psychiatry.
Monday, July 13, 2015
One of the paradoxes of child and adolescent psychiatry is that, at a time when teens are prescribed more medications than ever, teenage suicides are soaring. Antidepressants and antipsychotics are supposed to decrease suicide, not increase it.
A report of the Centers for Disease Control (CDC) of March 6, 2015, says that suicides per 100,000 population among persons aged 10-24 increased from 1.8 in 1994 to 3.1 in 2012, an annual increase of 3.0 percent. This is almost doubling over that 18-year period.
See the report here
Male rates are far higher than female, and suicides among male adolescents rose annually by 2.2 percent. But here is the shocker: suicides among female adolescents rose from 0.5 per 100,000 in 1994 to 1.7 in 2012, an annual change of 6.7 percent.
Hanging (“suffocation”) has soared among young women, and the CDC report noted a grim landmark: “Suffocation surpassed firearm as the most common mechanism of suicide among females in 2001.”
Whatever medications these young men and women receive are not working. A truly alarming increase in the consumption of psychopharmaceuticals has taken place at the same time as the increase in suicide. For example, the prescription of antipsychotic medications for patients under 20 rose from 300 per 100,000 population in 1993-95 to almost 1500 in 2002. (New York Times, “Beyond Ritalin,” June 6, 2006, 18)
Could there possibly be a connection?
Or do you "double down" and insist that the problem is that what we need is more drugs?
Guess what this shrink says. Yep, more DRUGS. without figuring out the source.
American Kids are the Most Medicated in the World I would say this is very suggestive.
Saturday, July 11, 2015
Michael Kessler was sentenced to state prison Friday for trying to lure a 13-year-old boy to meet him for sex back in 2013.
“Michael, why did you tell the court you're sorry? Are you sorry you got caught? Or are you sorry you did it?" Newswatch 16 asked Kessler. He had no response.
Former psychiatrist Michael Kessler of Cresco is headed to a state prison after his sentencing in Monroe County Court. Kessler admits trying to lure a 13-year-old by to meet him and engage in sexual activity, sending him child porn and more. The boy’s mother says she’s glad Kessler will be behind bars.
"It caused a lot of anxiety not knowing and knowing that he knew where I lived and was my friend and he targeted my son,” said the boy’s mother Janet VanHorn.
That mother says she monitors her children’s phones and Facebook accounts. Two years ago she caught Kessler posing online as a 14-year old boy and turned the case over to Monroe County Detectives.
"She paid attention. She caught it early. She was on top of things and she took the right steps,” said Detective Brian Webbe of the Monroe County Detective Office.
Kessler worked at Pocono Psychiatric Associates near Marshalls Creek before his license was revoked in 2012. Prosecutors say Kessler was arrested four other times for sexual incidents in Massachusetts and New Jersey without facing jail time.
"It makes you angry because all these years he thought he was above the law. It made me want to fight even harder to make sure he faced punishment,” said VanHorn.
Now Kessler faces a year and a half to five years behind bars. And this mother of two has a message for other parents after a long tough two years waiting for justice.
“Parents need to be aware that they need to keep up on your social media you need to check your kids' phones and their Facebook. You need to be on top of it all because if you're not, Lord knows what could have happened,” said VanHorn.
Friday, July 10, 2015
State of Conneticut Reaches False Claims Act Settlement with Providers at Children's Behavioral Health Clinic
A social worker and a doctor will pay a total of $120,000 to Connecticut's Medical Assistance Program (CMAP) through settlement agreements that resolve civil allegations involving the filing of false and fraudulent claims for payments at a Branford-based outpatient behavioral health clinic for children, Attorney General George Jepsen said today.
The state alleged that David M. Meyers, a licensed clinical social worker and former president of Cornerstones P.C., located in Branford, hired Dr. W. Blake Taggart to be the medical director of Cornerstones through an independent contractor agreement. Cornerstones' provider agreement with the state Department of Social Services (DSS) for participation in CMAP – which is the state's Medicaid program – required that the clinic comply with all applicable regulations. The state Department of Children and Families (DCF), which licenses and regulates outpatient psychiatric clinics for children, required Cornerstones to have a medical director. As part of Meyers' effort to maintain his clinic's enrollment in the CMAP beginning in January 2010, the DSS required an updated letter representing that Cornerstones continued to have a medical director overseeing care.
The state alleged that Dr. Taggart resigned as the clinic's medical director in September 2009, but two months later Meyers falsely stated in the letter to DSS that Dr. Taggart remained as the clinic's medical director. The state alleged that Dr. Taggart facilitated this misrepresentation by signing the false, back dated letter to DSS.
Wednesday, July 08, 2015
A Sad story of a woman trying to get help, and the failure of the psychiatric system in here city to help.
Snippet from a much longer story
The HSE has said it is to investigate concerns raised by a well-known Limerick businesswoman after she experienced "hell on earth" in a psychiatric hospital unit in Limerick.
Last November, Leona O'Callaghan, 35, spent two months at the 5B Psychiatric Ward in University Hospital Limerick, which she described as a "violent" and "uncaring" place.
"The HSE need to hear the voice of the service users," the mother of three said.
Ms O'Callaghan said she was forced to speak out publicly about her experience, because she got "no reply" to letters she sent to the Minister for Health, Leo Varadkar, and his Junior Health Minister, Kathleen Lynch.
In a searingly honest interview she described how after approaching a nurse in 5B, she was told she should kill herself if she really wanted to.
"There's an epidemic in suicide in Limerick. Obviously something is going wrong."
Tuesday, July 07, 2015
Abstract of the Report (Paid Access for full article)
This article is about ethics, specifically, the myriad of unethical practices characterizing recruitment for psychiatric trials.
Using a case study approach, honing on recruitment material, and examining the typical, the author explores recruitment in two studies—one involving electroconvulsive therapy, the other, a psychiatric drug. The bulk of the article is on these trials.
The ethical problems which surface include
The author also identifies some worrisome new trends. Of special interest to the humanistic counselor is the attempt to implicate people’s own counselors and therapists in recruitment.
- minimization of risk;
- lack of transparency;
- false and misleading claims,
- unfair inducement;
- failure to mention most of the common and serious negative effects;
- and a predatory quality.
The article ends with reflections on the onus that such practices place on all practitioners striving to be ethical.
The author concludes that it is critical that counselors and therapists not be complicit and beyond that they take it on themselves to confront and expose. Concrete practice suggestions include adopting an explicit policy against such referrals, alerting any clients who may be considering such trials of the danger, and countering false claims.
Monday, July 06, 2015
I was asked by David Healy to write my own story after he read my comment on another RxISK story. I agreed but have been surprised how hard it was to sit down and do it. I knew the story, the words were in my head. Yet I avoided getting started. Perhaps it was because of the painful emotions I knew it would bring to the surface. Or maybe because it reminds me of the pain and suffering my family had to endure, how much we lost and the fact that I may not be able to do anything about it. Or it could be my frustration from the cognitive difficulties I still have, making writing a difficult task that drains what little energy I have.
My trip started this way: I was ill, injured and in pain. I went to my doctors for help, and they proceeded to drug me into oblivion. My PCP or “family doctor” diagnosed me with fibromyalgia. I don’t think he really knew what I had, but once he put a name on my symptoms, he started throwing drugs at them. I was in constant pain, chronically fatigued and began to have severe bouts of anxiety. For four years I saw doctor after doctor but none of them could tell me what was wrong, or why I was getting worse not better despite all the drugs. It turns out I had autoimmune arthritis. I’d had it for 30 years, and since it was misdiagnosed and untreated for so long, my spine was a total wreck.
I have worked in construction for 38 years, as a skilled tilesetter with my own business. I love the work but it can be rough on the back. I am now on disability due to a combination of my disease and the multiple toxic “treatments” I was put on.
Before my trip through the Pharma looking glass began, I had quit drinking altogether. I had been sober for five years, solidly sober and liked it. In October 2010 I was on Trazodone and Wellbutrin. When Flexeril and Naprelan were added, within weeks I suddenly had strong urges to drink, which had been totally absent until that point. I now know that Flexeril (cyclo-benzaprine) acts just like a tricyclic antidepressant and should never be mixed with trazodone or Wellbutrin. The urge and the thoughts of drinking came on suddenly and very strong.
I made two trips to alcohol rehab, attended AA regularly but could not stay sober to save my life. I had numerous run-ins with the law as well. My behavior had become so bizarre, unpredictable, unstable and dangerous that I thought I had lost my mind and myself completely. I had no control over my thoughts, emotions or behavior, no matter what I did or how hard I tried. I watched my family suffer horribly in fear and confusion at what was happening.
Now I know why. Drugs can drive people to drink for relief from the agonizing akathisia that they cause. Couple that with the disinhibiting effect of the drugs, and it’s a recipe for alcoholism. That’s not just true for the antidepressants, but Lyrica too. The warning on Lyrica says that “People who have had a drinking problem in the past may be prone to abuse Lyrica.” It really should say: “If you take Lyrica you may have strong, uncontrollable urges to drink.” Lyrica can cause alcohol abuse, I have no doubt. So can Cymbalta, Zoloft and several other drugs I was on. I didn’t have a chance in hell to stay sober on those drugs.
From a column in Psychiatry Today by Robert Berezin M.D. While I do not think that psychotherapy is very workable, his criticism of psychiatry is spot on.
Once again, I just finished another consultation with someone from out of state who was desperate to find a therapist who he could talk to. He didn’t want to be pigeon holed into some DSM-5 reductionistic diagnosis. He didn’t want psychiatric drugs. He was desperate to find a psychiatrist who would understand him, who he could relate to, and could treat him with real psychotherapy. There should never have been a reason for me to consult with anyone from out of state. Unfortunately, the cynical and fraudulent takeover of psychiatry is all but complete. How many real psychiatrists are left?
How did this happen? Over the course of my career, I kept my head down and devoted myself to my craft, psychotherapy. I was certainly aware of the collusion between the APA and the drug companies. But as recently as ten years ago, I honestly did not know that things had really deteriorated this far.
Apparently, Dr. Jeffrey Lieberman and other like-minded psychiatrists, decided that psychoanalysis had too much power, and they wanted to transform the APA once again to the tenets of somatic psychiatry. The underling theory of somatic psychiatry is that the source of human struggle is considered to be the brain itself, rather than the person.Treatments that follow from this simplistic, mechanistic, and reductionist notion have been to act directly on the brain, always with violating and destructive outcomes.Somatic psychiatry originated with seizure therapy, or its first modern incarnation, insulin shock therapy (IST). It actually had its roots in the sixteenth century and was used psychiatrically around the time of the American Revolution. It was refined in 1927 into insulin shock therapy, when insulin was used to induce seizures as a treatment for drug addiction, psychopathy, and schizophrenia, with claims of a 50 percent remission rate. Papers were published in the American Journal of Psychiatry, starting in 1937. IST was widely used through the 1940s and 1950s. Its founding etiological principle was the (false) idea that seizures were the opposite of schizophrenia. Induce a seizure, and you balance out psychosis. In the 1930s, a more refined scientific explanation was developed for the (phantom) curative power of seizures. Its science proclaimed that psychiatric problems came from the autonomic nervous system. IST was said to work by blocking the nerve cells of the parasympathetic nervous system, thereby intensifying their tonus and strengthening their anabolic force. This restored the nerve cell, and the patient recovered. The corollary theory was that patients were jolted out of their psychiatric condition.
Next, we have lobotomies, originally called leucotomies. Lobotomies came onto the scene in the 1930s, having been invented and promoted by Antonio Egas Moniz. When I was a psychiatric resident, lobotomies were still fresh in psychiatric memory. The practice had only ceased in the early 1960s, after over twenty thousand people received this “treatment.” Let’s see … what was the science? The source of psychiatric problems was located in the brain, specifically the prefrontal cortex. The treatment of choice, then, was to ream out the prefrontal cortex with an ice pick. Respected MDs had a miracle cure and were the vanguard of the field. Science proved that lobotomies cured not only schizophrenia but anxiety, depression, low self-esteem, obsessive/compulsive disorder, and the unwanted behavioral problems associated with mental retardation (this is code for sexual behaviors). It was respected and celebrated in the psychiatric literature and validated in journals with documented studies and peer-reviewed scientific evidence. Lest you think this is an exaggeration, Moniz won a Nobel Prize in 1949 for his great and wonderful discovery.
Eventually, the validating follow-ups were shown to be fabricated and deluded, with self-promoting lies and half truths. Only after a great deal of harm were they debunked. And the ice picks were thrown into the trash heap of psychiatric history. We need to add that after lobotomies gradually attenuated, no one stopped and said, “What in the world did we just do?” How could sticking an ice pick in someone’s brain ever have been even a remote consideration? What was going on that such a grotesque medieval mutilation was actually adopted as a good thing to do? And how could it have been publicly and professionally embraced? However, as always seems to happen, amnesia quickly set in, and we forgot the brutal inhumanity that was so recently celebrated. And the considerable body of discredited scientific validation was never scrutinized for its contribution to and for having promoted such harm. Instead, science moved on to support the next somatic treatment in exactly the same way.
Next, we have electroconvulsive therapy (ECT), which came along soon after IST, in 1938. ECT was still a part of the curriculum in my own psychiatric residency in 1971. Entire psychiatric hospitals, built exclusively for ECT, were still operating, with no empty beds. Scientific studies and respected journals provided documented validation for placing electrodes on patients’ heads and applying huge jolts of electricity to generate seizures. Apparently, the jolt theory had gained traction. So we shocked the brain, instead of reaming it out. How humane. In addition to everything else, ECT also was touted as a cure for depression. It was allegedly proved that ECT was a safe, effective cure, with few, if any, drawbacks. The resultant memory loss not only was initially downplayed but was trumpeted as being therapeutic. (By the way, drugs are being developed today to chemically erase memories with the idea that this is therapeutic for trauma—same thing.) Later, under public pressure, ECT was refined to cut down on memory loss. The history of electroconvulsive therapy followed the same trajectory as lobotomies. Eventually, ECT showed itself to be the ineffective and violating practice that it is. But don’t get overconfident. Incredibly, in recent years, ECT has made a comeback and is being promoted once again, when its progeny treatments, antidepressants, don’t work.Finally, we come the current incarnation of somatic psychiatry - neurobiological psychiatry, and its so-called treatment—drugs. Psychiatric drugs are next in the lineage of “treatments” whose focus is to act upon the physical brain. History is repeating itself.Our contemporary science has now apparently proven that human problems come from genetic or developmental neurobiological disorders of the physical, anatomical, biochemical brain. The somatic treatments for these neurobiological, genetic, synaptic hormonal neurotransmitter diseases are brain drugs—psychoactive drugs.In one generation, the APA, in collusion with the drug companies have destroyed psychiatry. The American Public has been sold a bill of goods.People actually believe that human struggle is a brain disease. It is now taken as fact that there is a chemical imbalance in the brain and psychoactive drugs is just what the doctor ordered. We can now cure biological depression with antidepressants; biological anxiety with benzodiazepines; the fictitious ADHD with, of all things, amphetamines; insomnia with benzodiazepines, and other bizarre psychoactive drugs; Likewise the belief is that schizophrenia and manic-depression should be treated with drugs [...]
Friday, July 03, 2015
The bulk of the Medicare and Medicaid fraud allegations against Gibson, et al. center around Riverside’s psychiatric facilities, which are classified by the government as a “partial hospitalization program” (PHP) A PHP is technically an outpatient treatment facility, but is geared toward the round-the-clock care required for patients enduring a severe mental illness. Under government guidelines, mental health patients receiving care at a PHP must be routinely seen by a psychiatrist, guided through a care plan, and carefully monitored throughout the course of treatment.See Also
According to the allegations, Riverside collected more than $158 million in funds from Medicare and Medicaid on behalf of PHP patients who rarely, if ever, saw a psychiatrist for their illnesses. Moreover, Riverside regularly billed the government for psychiatric services that were never rendered, mostly because the patients were in the advanced stages of dementia and unable to participate in the treatment.
Patient care aside, Riverside is also accused of offering kickbacks and financial incentives to executives group homes, as well as recruiters tasked with increasing referrals of mental health patients to Riverside’s facilities.
In addition to the three main participants listed above, six other individuals recently pled guilty to conspiring with Gibson to bring in the maximum number of Medicare and Medicaid clientele.
According to a statement by the U.S. Attorney General’s Office, “The former President of Houston’s Riverside hospital, his son, and their co-conspirators saw mentally ill, elderly, and disabled Medicare beneficiaries as commodities to be turned into profit centers – not as vulnerable individuals in need of health care….Rather than providing needed medical care to a historically underserved community, the defendants ran a longstanding hospital into the ground through their greed and fraud. According to the evidence presented at trial, the defendants had patients sit around the facility watching movies while they received no treatment. Meanwhile, the defendants billed Medicare more than $158 million for care that was never provided. This brazen fraud cannot and will not be tolerated.”
Department of Justice Press Release, “Former President of Riverside General Hospital Sentenced to 45 Years in Prison in $158 Million Medicare Fraud.” June 9, 2015.
Saturday, June 27, 2015
To assert psychiatry is careless in prescribing drugs for its various diagnosed disorders is a monstrous trivialization of the problem.
Many of their drugs have been directly linked to suicide and violent behavior, sometimes resulting in murder on a grand scale. In a 2011 study based on data from the FDA’s Adverse Event Reporting System, 31 drugs were linked with violent behavior.
Here are some of the worst offenders:
- Varenicline (Chantix) – Some of the side effects listed for this smoking cessation drug, which is 18 times more likely to result in violence, includes:
- Seeing things that are not there
- Suicidal Thoughts
- Behavior Changes
- Mood swings
An Oregon woman found her husband and son dead, both killed by her husband (who had been prescribed Chantix by his dentist.) There have been many other instances of homicide traced back to this drug. Why Chantix has not been withdrawn from the marketplace is hard to fathom.
- Prozac – This antidepressant is 10.9 more likely to be associated with violence than other medications. This drug has over 80 side effects, ranging from merely uncomfortable, to deadly. Here a few of the worst:
- Use of extreme physical or emotional force
- Suicidal thoughts
- Violent behavior
- Panic Attacks
- Abnormal thoughts
By the year 2000, Eli Lilly had paid $50 million dollars to settle 30 prozac lawsuits involving suicide and murder by those at the mercy of this drug.
- Paxil – This antidepressant is linked to birth defects and severe withdrawal symptoms. It has a 10.3 likelihood of violence associated with it. Some other Paxil side effects include:
- Auditory Hallucinations
- Suicide attempts
- Aggravated Nervousness
- Acting aggressive or violent
- Acting on dangerous impulses
Donald Schell had been on Paxil for only 48 hours when he shot and killed his wife, daughter, his granddaughter and himself. The case came to trial, and a jury found GlaxoSmithKline liable for the deaths, and ordered the drug company to pay 6.4 million dollars to the relatives of Schell.
- Amphetamines – This includes Adderall, used to treat ADHD in children. It has been linked to suicide and violent behavior. Just a few Adderall side effects include:
- Tourette’s syndrome
- Suicidal thoughts
Kyle Craig’s parents are living with the horrendous loss of their son, a victim of this drug’s suicidal side effects. At the age of 21, while a college student at Vanderbilt University, he stepped in front of a passenger train and ended his life.
- Fluvoxamine (Luvox) – This drug is used to treat obsessive compulsive disorder, and has been linked to violent behavior. Here is a partial list of its side effects:
- Impulsive behavior
- Suicidal thoughts
Eric Harris, perpetrator of the 1999 Columbine school shooting tragedy in which 12 students were murdered and another 21 were injured was on Luvox.
Why are these drugs still on the market?
It seems a mystery, since the vast number of people would be happy to see these violent inducing drugs disappear forever.
But psychiatry maintains a fondness for these drugs and their unholy alliance with big pharmaceutical companies keep violent inducing drugs in production.
It is up to each of us to educate ourselves on the side effects of these drugs. There is often a medical reason behind a so-called mental disorder, and examination by a competent (not psychiatric) medical doctor can often trace back the problem to a physical cause.
Treatment with psychiatric drugs is very much playing Russian roulette with the lives of our loved ones.
Thursday, June 25, 2015
A 56-year-old man who works as a mental health specialist for Santa Cruz County was arrested Thursday morning.
Christopher McCauley is a well-known mental health specialist and community liaison at the county's Health Services Agency. According to his Facebook page, he works with children for the Health Services Agency. He was booked into jail on suspicion of sexually assaulting a child who is younger than 11 years old. His bail was set at $100,000.
Sheriff's deputies said Child Protective Services agents alerted them about McCauley's inappropriate behavior. McCauley was arrested by sheriff's deputies at 1400 Emeline Ave., where he works in the county health department's building. McCauley is the first person who schools are instructed to call under the Santa Cruz County School Emergency Mental Heath Response Protocol.
Rayne Marr, Public Information Officer for Santa Cruz County, issued the following prepared statement to KSBW:
"This morning a county mental health client specialist in the Health Services Agency was arrested. The county is cooperating fully with law enforcement officials and remains steadfast in our commitment to providing a safe and secure environment for our clients. As you know, the employee does have a right to privacy and the county cannot comment on an ongoing law enforcement investigation," Marr said.
When asked if McCauley worked with children for the county, she declined to comment. Calls to McCauley's work phone number were not returned.
The Sheriff’s Office believes that there may be more victims. Anyone with information pertaining to this investigation is asked to contact the Santa Cruz Sheriff's Office Sexual Assault Unit at 831-454-7630.
Wednesday, June 24, 2015
If you’re not familiar with it, Suboxone is the brand name of a drug that is used in the treatment of opiate addiction. It was recently in the news because the young man who shot and killed several people in South Carolina had been recently arrested for possessing Suboxone that wasn’t prescribed for him. Could Suboxone have been involved in mental problems that contributed to his shooting these people? To determine this possibility, it’s necessary to take a closer look at this drug and its side effects.
What’s in Suboxone?
The primary drug in this formula is buprenorphine, a synthetic opioid (meaning “similar to opiate”). This drug prevents an opiate-addicted person from going into withdrawal but does not create as much euphoria as heroin or painkillers. So it is broadly used in the treatment of opiate addiction, enabling people to stop using heroin or painkillers without the sickness that would normally result. One report estimated that three million Americans have been treated with Suboxone.
Despite the high not being as potent as that of heroin, it’s still a popular drug of abuse, with many drug dealers offering their customers their choice of heroin or Suboxone. If there are any hazardous mental side effects to using or abusing Suboxone, all those people illicitly using this drug will not have the support of a doctor to cope with those effects.
Suboxone Side Effects
The website for the manufacturer, Reckitt Benckiser of the UK, notes these side effects of the drug: Nausea, vomiting, headache, numb mouth, constipation, intoxication, disturbance in attention, irregular heartbeat, decrease in sleep, back pain, fainting, and dizziness.
Pharmaceutical company Reckitt Benckiser lists no mental effects of this drug. Their website only states that there are “nervous system” effects such as: Anxiety, depression, dizziness, nervousness and insomnia.
The Substance Abuse and Mental Health Services Administration notes this side effect: Dysphoria, defined as a state of depression, restlessness, or unpleasant dissatisfaction with life.
But What Do Actual Users Say about Suboxone?
Some recent news reports have ventured into online forums that permit drug users to discuss the effects of the drugs to find out what these actual users say about side effects. While these are not authoritative sites by any means, it might be useful in this circumstance to sample their comments.
In 2011, a woman described her experience using buprenorphine in a patch as prescribed for pain: “I became extremely angry and irritable. I was having other problems with it and wound up taking the patch off. When I put a new one on last night, the same thing happened. Ten minutes and tears just started pouring. I couldn’t stop it! Half an hour after that I was high as a kite, not happy but talkative. Twenty minutes later I felt the need to punch someone in the face, and I’ve been irritable and bitchy ever since. I feel like gruesomely and meticulously dismembering every other person I come across, just because.”
This person stopped using Suboxone while he was taking 6 milligrams per day: “On the fourth day I wanted to kill myself. Whoever says Suboxone is easy to come off is a better person then I am.”
In 2013, a fellow who was trying to get clean after using 2 mg Suboxone for six months said: “I set a new world’s record, at least my personal best, 27 days with no sleep! On a 2 a.m. walk at night 26 I was seriously ready to jump out into traffic, I was hallucinating and could barely walk, and once you think you’re getting better, it comes back and kicks you in the ***!”
In 2014, a person who had been taking Suboxone for two years and then went off it said: “The INSANE anxiety has settled in to stay. I make myself sick obsessing over what I need to be doing and what is about to go wrong and how in the world I am going to make it through. I sit and think and in the middle of everything I do, chores, driving, watching TV, suddenly my heart sinks as I sit and entertain one of my negative thoughts in my head.”
A man with the forum name of “Dan Steely” described the effect of taking one to two mg of buprenorphine a day for eight months: “It took me months to figure out I had turned into a zombie. Like I said I could function pretty well but my life had become very flat. I no longer enjoyed or looked forward to the things that made my life fun.”
A person with the forum name “Shanellie” mentioned in 2012: “Subs are just not for everyone. I tried that route and basically spent an entire year feeling weird, sick and miserable.”
There’s no drug in the world that works for every single person which is why it’s vital for a patient to stay in touch with a doctor when starting treatment. When a person is abusing this drug or does not have a trusting relationship with his doctor, it’s possible for things to go very wrong, as these people have noted.
Was Suboxone Abuse Related to this Recent Tragedy?
This is a question that doctors and other qualified experts will need to answer. What does seem clear is that Suboxone and buprenorphine don’t work for every patient and have some serious mental side effects for some. When these drugs are being used without medical supervision, there’s no telling what could happen.
A Queensbury psychiatrist had his medical license suspended for 6 months for allegations of “gross incompetence” and “moral unfitness.”
A Queensbury psychiatrist had his medical license suspended for 6 months last week after the state Department of Health brought a disciplinary case against him for allegations of “gross incompetence” and “moral unfitness.”
Dr. Koock E. Jung, who operates Psychotherapy Center on Bay Road in Queensbury, will also spend 3 years on probation after the suspension is lifted, according to the Department of Health. The suspension takes effect June 29.
The Department of Health website showed Jung admitted he “could not successfully defend against” at least one of a group of charges that included allegations he committed “gross negligence gross incompetence negligence on more than one occasion incompetence; on more than one occasion harassing, abusing or intimidating a patient physically or verbally; engaging in moral unfitness; failing to maintain accurate patient records; and revealing personally identifiable facts, data or information without the prior consent of the patient.”
Among the allegations was inappropriate physical contact with female patients and prescription of medications that were beyond his licensing ability, according to one woman who made a complaint against Jung. Jung denied the accusations Tuesday and said he did not admit any wrongdoing related to sexual contact. He said any physical contact he had with patients was for legitimate medical or examination purposes. He blamed the case on a group of disgruntled former employees, one of whom he had remove her shirt so he could examine her for pneumonia. He said some of them told “lies” because they were angry about a “pay scale” dispute.
Other patients wrongly interpreted examinations he did to check their hearts for problems related to medication they were prescribed, he said. “Some of these women sexualize anything,” he said.
The prescription charge related to prescribing Xanax to a person with “serious anxiety,” Jung said.
He said he suffers from Lyme disease that has limited the use of his hands, so he may decide to retire instead of getting his medical license reinstated. Jung accepted the state’s disciplinary action instead of facing an evidentiary hearing that could have led to him losing his medical license. The hearing was scheduled for last week, and the notice of discipline was posted Monday.
A Queensbury woman was among the dozen or so women, many of them victims of sexual abuse, who sought help from Jung. She said they were prepared to testify at the disciplinary hearing last week. She spoke on the condition of anonymity because of the nature of the allegations. She said Jung engaged in “inappropriate touching” and inappropriate conversations with her and others with whom she discussed the case.
Friday, June 19, 2015
My heart aches and my soul is full of sadness for the nine innocent lives lost in Charleston, South Carolina, and the community left reeling due to yet another senseless crime. This horrific mass murder will no doubt be remembered in American history, just like the many others that have come before it, and unfortunately the probable ones yet to come.
While we know that accused killer Dylann Roof was fueled by hatred and racism, I wonder if there is a pattern in some of these tragedies. In conjunction with what other experts will tell us, I believe that an epidemic of drug abuse in this country is helping to fuel the violence. I am not talking about marijuana, cocaine or heroin – I am specifically singling out prescription drug abuse.
It is alleged that Roof was taking Xanax and Soboxone. A high school classmate even referred to him as a “pill popper.” The Wall Street Journal reported that in a police incident report from February, Roof was found to have strips of Suboxone -- a pain drug used to treat opiate addiction -- on him, but did not have a prescription for the drug. From what we know thus far, Roof was not under any kind of psychiatric care, either.
Now, I don’t know for sure whether or not Roof had a prescription for Xanax, or if he purchased it off the street like his former classmate inferred, but the drug has been linked to many potential dangerous side effects without careful monitoring. Xanax may cause a person to become depressed, irritable, an insomniac, to have difficulty concentrating, and to act in an aggressive manner. When psychiatrists and physicians prescribe Xanax, they are aware of these side effects, and determine the proper dosage to prescribe to patients based on any underlying mental illnesses. However, when the drug is purchased off the street, there could be undiagnosed disorders like bipolar disorder or another mental illnesses that could cause the above-mentioned side effects to come to life, often in tragic ways.
Suboxone is another powerful drug that requires a degree of professional monitoring. This is typically prescribed for narcotic addiction because it contains both a narcotic element, along with an anti-narcotic ingredient. The combination of this drug and Xanax could create a poisonous cocktail that may spell trouble for the user.
Many of these drugs are sold on the streets by people who have obtained them illegally. A National Household Survey on Drug Abuse indicated that an estimated 36 million U.S. residents aged 12 and older abused prescription drugs at least once in their lifetime. In breaking that number down, it found that 2.7 million of those individuals were aged 12 to 17, and 6.9 million were aged 18 to 25. Those purchasing the drugs are unaware of potential side effects or the dangers that they may pose to others while on the medications.
Make no mistake about it, these are powerful drugs intended to treat many mental illnesses. Most of them, if they are taken as intended, do provide great relief to patients. However, there are instances of violence that have occurred while suspects were under the care of a psychiatrist and were taking the prescriptions legally.
Let’s look at James Holmes, the accused killer who opened fire on a movie theater in Aurora, Colorado, killing 12 and wounding 70. Holmes had been prescribed a generic version of Zoloft, which is used to treat depression, panic disorder and obsessive-compulsive disorder, and Clonazepam, which treats anxiety and panic attacks. Zoloft has the potential to cause suicidal ideation, while Clonazepam also carries the potential for serious side effects.
Next, let’s consider Eric Harris, who along with Dylan Klebold, opened fire on April 20, 1999, at Columbine High School, murdering 13 classmates before killing themselves. Harris had been prescribed the powerful antidepressant Luvox.
One in 10 Americans now takes antidepressant medications and many others illegally acquire these drugs for recreational use. I am certainly not suggesting that one in 10 of us is a killer. What I am saying, is that when these powerful medications are given, they must be medically supervised, and all of the side effects must be considered by the prescribing doctor. When there is no medical supervision, or lax guidance, these drugs can enhance aggressive behavior and further fuel irrational thinking. The illegal prescription drug abuse on the streets is far too great for us to ignore.
As the nation once more looks for answers to an unthinkable tragedy, many will race to call for better gun control and background checks. Others will want social answers and call for better ways to mend the racial divide that exists in some of our communities. But what I ask our leaders is to also address the epic level of untreated mental illness in our country, which when paired with illegal drug abuse, has only left us reeling time after time.
We all need to work together. Just recently the Justice Department arrested 243 people across the country and charged them with submitting fake billing for Medicare which totaled $712 million. Among those arrested are 46 doctors, nurses and other licensed medical professionals. In one case, a doctor in Michigan prescribed unnecessary narcotics in exchange for patients’ identification information to generate false billings.
Uncontrolled drug abuse in people that already possess racism and hatred in their hearts makes for an incredibly dangerous situation.
Each and every one of us will play a role in righting this wrong, and it begins with caring for each other. If you notice changes in any of your loved ones, friends or colleagues, then you must speak out. Too often after the fact we hear of all the warning signs that were there for us, whether it was the lack of compassion for your fellow man, drug abuse or mental illness, it is our responsibility to get them help. Let us hope that this hate crime will make every single American know how to love and respect and care for each other, because that will be the definitive cure that will make us stronger and better people.
Thursday, June 18, 2015
Fairfield psychiatrist charged with fraud. They submitted bills that added up to them seeing patients 24 hours a day.
The state attorney general is suing a Westport couple for Medicaid fraud, charging they submitted bills that added up to them seeing patients 24 hours a day.
Attorney General George Jepsen announced Thursday morning that Dr. Ashwini Sabnis, a psychiatrist, and her husband Saurav “Sam” Mohanty, co-owners of Brighter Concept, Inc., 2000 Post Road in Fairfield, allegedly filed false claims under the Connecticut Medical Assistance Program. The couple also operated a Brighter Concept office in New Haven.
Jepsen said he is seeking triple damages under the state’s False Claims Act for actions that occurred between January, 2010 and December of last year, including billing for services that garnered higher reimbursement levels than the services they actually provided. Jepsen alleged that the couple overbilled the state Department of Social Services by $768,171 during the four-year period.
The lawsuit, pursued by Jepsen and Department of Consumer Protection Commissioner Jonathan Harris, was filed in Hartford Superior Court.
"This action is being brought to seek damages, civil penalties and other relief due to a scheme that was perpetrated on a health care program intended to care for our most vulnerable citizens," Jepsen said in a statement. "Health care providers who accept taxpayer dollars must play by the rules."
The couple’s attorney, Ross Garber, declined comment.
The 42-page complaint alleges that the scheme included claims for services not rendered, as well as overbilling and filing false statements in a “systematic and persistent pattern of submitting false and fraudulent claims.” The lawsuit alleges that Sabnis and Mohanty discouraged auditors from the state Department of Social Services with claims that their computer system had crashed.
Sabnis regularly overbooked her scheduled Medicaid patients for 15 or 30 minute appointments, saw them for as little as 5 or 10 minutes, then used a reimbursement code that showed she spent as much as 75 to 80 minutes with them, the complaint said. The lawsuit alleges that there were 113 days when Sabnis billed the state for more than 24 hours of service for low-income and disabled patients.
Department of Social Services Commissioner Roderick L. Bremby praised the Attorney General’s investigation.
“Uprooting and eliminating this type of fraudulent activity requires the constant vigilance of oversight agencies,” Bremby said. “While the great majority of Medicaid-enrolled providers are professional and honest, the exceptions require aggressive action on behalf of the program’s overall integrity and the taxpayers who fund it.”
Monday, June 15, 2015
A new Blog entry by Jon Rappaport entitled The Devious Matrix Called Psychiatry
A very long article well worth the read. Here's the intro
“Psychiatry does more than define mental disorders. It purports to describe actual states of mind, and it coalesces and freezes those descriptions in such a way that people believe these states of mind exist. They don’t. They’re fictions. Fantasies. This is an enormous landscape of consciousness-programming. It’s actually reduction. Like many systems before it, psychiatry tries to reduce the possibilities of wide-ranging free consciousness. Throughout history, people have always been afraid of mind freedom. ‘What will people with free minds do?’ ‘What will society become if people’s minds are free?’ I can tell you: society would change radically, right down to its foundations.” (The Underground, Jon Rappoport)
Over the past 30 years, my work has always returned to freedom of the individual.
Not only Constitutional freedom and Bill-of-Rights freedom, but liberation of the power of individual thought and imagination and invention. Because those qualities are unpredictable, open-ended, and limitless. This is where long-term revolution begins.
So naturally, I’ve investigated the premier “science” that claims to have the best understanding of the mind: psychiatry.
I was neither surprised nor shocked to discover that psychiatry is a fraud, a pseudoscience.
Yet, this “science” is accorded special treatment and licensure and favored status by governments around the world. Why? Because untold numbers of patients can be diagnosed and drugged with highly toxic substances, and even held against their will in closed wards. Dissidents can be contained. Whole populations can be convinced they are either “mentally healthy” or “mentally ill,” as if those two fictional categories described some highly significant status.
If psychiatry were merely recognized as an experimental hypothesis, and so-called professionals diagnosed one another and applied labels to one another and drugged one another, in order to assess the outcome, as any scientist would, before subjecting the public to his idiosyncratic notions…well, fine. I could understand that.
But of course, this is not where we find ourselves. Psychiatrists are considered lofty authorities. They are called as expert witnesses in criminal trials. Then can, in many cases, arbitrarily force their will on patients. They are called upon by media to render their analyses. They occupy sanctified chairs at universities.
So…with that introduction, let me present information which has not been broadly communicated to the public.
Saturday, June 13, 2015
An East Tennessee State University medical school psychiatrist Sues Claiming False Arrest for DUI (Despite Failing Streetside Sobriety Tests)
Apparently local Law Enforcement was not appropriately deferential and arrested him because he failed the tests. Also, if he is in such rough shape (as alleged in the lawsuit), what business does he have being a psychistrist? Note this quote from the story:
Also, during the booking process, Agrawal said Stillwagon’s data entry device made a “machine gun” sound, which further terrified Agrawal.I sure wouldn't want him even as a regular doctor! Paranoia anyone?
It is rare that a shrink gets the same treatment that patients often do. He also sounds like he is looking for a payday
From a report in the Johnson City Press
An East Tennessee State University medical school psychiatrist at the Veterans Affairs Medical Center, Mountain Home, has sued Washington County, Johnson City and a city police officer over an alleged bogus DUI arrest and his treatment while jailed nearly 36 hours.
Dr. Newton Agrawal filed the lawsuit through his attorney, Richard Pectol, in Washington County Circuit Court May 28, almost one year to the date of his arrest. Agrawal was pulled over around 11:50 p.m. on May 30, 2014, near the intersection of Buffalo and East Main streets by Johnson City Police Officer Kirt Stillwagon and ultimately arrested on two charges — DUI and violation of the light law. Months later, blood alcohol test results showed no alcohol in Agrawal’s system and a toxicology report indicated all drug tests were negative. Both charges were dismissed by state prosecutors in October.
According to the filing, Agrawal had attended a gathering of co-workers at Gourmet & Co. earlier in the evening, where he had one alcoholic drink around 7 p.m. During the time at the restaurant, Agrawal ate a meal and drank water. Around 11:30 p.m., Agrawal left the restaurant to drive home, but was pulled over by Stillwagon, “purportedly for driving with a headlight that was not illuminated,” the suit states.
Agrawal apparently admitted to Stillwagon that he had been at Gourmet & Co. and consumed one alcoholic drink. That’s when Stillwagon asked Agrawal for his license and vehicle registration. According to the warrant charging Agrawal with DUI, Stillwagon said the doctor “fumbled papers, losing focus on what was asked originally.” The warrant does not indicate Stillwagon smelled alcohol, observed bloodshot eyes on Agrawal or that Agrawal had slurred speech or was driving erratically.
Stillwagon then administered several field sobriety tests — finger dexterity, on which Stillwagon said Agrawal did poorly; recite the alphabet from E to Q, which was performed correctly; horizontal gaze nystagmus — the follow-my-finger” test; as well as the walk-a-straight-line test. Both of the last two tests were performed poorly, according to Stillwagon’s affidavit of the arrest.
Agrawal stated in the suit that he was forced to conduct the field sobriety tests on a sloped surface while wearing formal shoes and with flashing lights from three police cars blinding him. He also asked Stillwagon to allow him to calm down for a few minutes because the act of being pulled over, and that multiple police officers responded to the traffic stop, caused him to be nervous and anxious. The lawsuit indicates Stillwagon refused Agrawal any time to calm himself before performing the tests, and he also denies performing poorly on the tests.
Stillwagon took Agrawal to Johnson City Medical Center approximately one hour after the stop for a blood test, but did not perform a breathalyzer, according to the lawsuit.
Once at the jail, Agrawal said he was mistreated by booking officers who refused to allow him to call to a bondsman, tried to force him to sign a statement indicating he was suicidal and then refused Agrawal a mental health assessment when he requested one. Following the booking process, Agrawal said he was told to strip naked, and was then placed in a suicide watch cell where he was kept from May 31, 2014, until the morning of June 2, 2014. Also, during the booking process, Agrawal said Stillwagon’s data entry device made a “machine gun” sound, which further terrified Agrawal.
During that time in the suicide watch cell, Agrawal said he was given only a thin paper sheet to cover himself and was housed with two inmates also placed on suicide watch. Also, Agrawal said he attempted to get the attention of booking officers numerous times to ask to arrange for bond and for his heart medicine, but he was ignored by the officers who sat just feet away from the cell.
Agrawal said in his lawsuit that he did not receive a mental health assessment until June 2, and it was conducted over the phone. That morning he was also allowed to call a bondsman so he could be released from jail. ”Stillwagon’s tortuous acts and omissions as described ... will continue to cause (Agrawal) to suffer fear, terror, nightmares, embarrassment, humiliation, damage to his professional reputation as a medical doctor .... emotional stress, mental anguish, a disruption of his normal everyday life activities, and a loss of the enjoyment and pleasures of life,“ the suit states.
The suit, which states Agrawal also suffered physically from being “slammed by Stillwagon onto the hood of his patrol car and onto the counter in the Washington County Detention Center,” asks for a judgment against the defendants for a total of $1.8 million in compensatory damages. The lawsuit had not been served on the city, county or Stillwagon as of Wednesday morning. Once it is served, the parties have 30 days to file a response.