Wednesday, February 25, 2015

Prashant Tiwari's family files $12.5M lawsuit after suicide in Brampton, Ontario hospital

As reported by the CBC

Many more details at the link

Members of a Brampton, Ont., family have launched a $12.5-million lawsuit after a 20-year-old man was found dead in the bathroom of the hospital where he was supposed to be on suicide watch.

Prashant Tiwari committed suicide last June at Brampton Civic Hospital while under treatment, the lawsuit alleges, adding he had been admitted to the psychiatric ward after he had started cutting himself.

Rakesh Tiwari alleges his son was left unattended in a hospital bathroom for three hours. During that time, the 20-year-old used his hospital gown and a chair to hang himself, his father said.

"He volunteered himself to the hospital. He knew he had some problem, and he was fighting and he needed help," said Rakesh Tiwari.

"He was not to die."

Tiwari believes staff were supposed to check on his son every 15 minutes.

"My son should not have been unattended," he said.

A lengthy statement of claim — filed at Brampton's Superior Court of Justice on Wednesday — names the hospital and numerous employees as defendants, and lays out a timeline of what happened to Prashant Tiwari in the hospital.


After his death, the statement of claim alleges, 12 people accessed Prashant’s medical records without proper authorization for unknown reasons.


California Lawmakers blast overuse of psychiatric drugs on foster kids

from this report in the Tribune in San Luis Obispo

California lawmakers on Tuesday blasted the overuse of psychiatric drugs on the state's foster children and pledged to improve the lives of thousands of vulnerable teens after more than a decade of government inaction.

"We can't let another decade go by without creating a system of care, a system of care that is capable of helping kids heal from the challenging experiences they have lived through or protecting them from further harm," said Sen. Mike McGuire, D-Healdsburg, in opening a joint Senate Human Services Committee and Senate Select Committee on Mental Health.

Advocates said the state's foster children are being prescribed psychiatric drugs at three times the rate of other youth. Since 2006, the use rate of psychotropic medications has nearly doubled, McGuire said. He noted that it's costing taxpayers millions of dollars through the state's low-income health program Medi-Cal.

Iris Hoffman, a member of the California Youth Connection in Sonoma County, told lawmakers how she spent her childhood in juvenile homes, group homes and treatment centers while heavily medicated on the anti-psychotic drugs Abilify and Seroquel. She and other foster children were fearful of retribution if they refused drugs that made them drowsy in class, Hoffman said.

"When you're in those situations, there's all kinds of punishments and things you have to be fearful of if you are to refuse medications prescribed to you by a psychiatrist that only meets with you for an hour a month," she said.

Democratic lawmakers are proposing several pieces of legislation to improve oversight after an investigation by the Bay Area News Group found that thousands of vulnerable teens in foster care are being prescribed antipsychotics that could trigger diabetes, tics, weight gain and drowsiness.

Sen. Jim Beall, D-San Jose, said Tuesday that the hearing at the Capitol is only a step in determining whether the drugs are being administered as part of a therapeutic regimen or "being used as a chemical straitjacket solely to control their behavior."

Beall and Sen. Holly Mitchell, D-Los Angeles, have proposed SB238, which would alert caretakers when drugs are overprescribed and warn of dangerous drug interactions.

Beall also plans to introduce two other bills — one calling for public health nurses to oversee the medical monitoring of children's medication, and the other to establish treatment protocols and oversight in group homes.

Lawmakers on Tuesday heard from medical professionals, child welfare directors, family service advocates, foster youth and officials from California's health and social services agencies.

The use of psychiatric drugs has increased even though the state's foster care population has dropped. As a result of reforms that emphasize keeping children with their families whenever possible, the number of children in foster care has dropped from 103,000 in 2000 to about 55,000 in 2013.

Lawmakers say nearly a quarter of adolescents in California's foster care youth system are prescribed powerful psychotropic drugs. According to the National Center for Youth Law with data provided by the state, 36 percent of them are taking multiple medications that carry harmful side effects.

Antipsychotics, antidepressants, ADHD drugs, anti-anxiety medications and mood stabilizers are some of the psychotropic drugs.

Tuesday, February 24, 2015

Judge: State of Alaska can't hold foster kids at mental hospital for indefinite stretches

From a report in the Alaska Dispatch News

More details at the link

Facing allegations that it improperly warehoused foster children at North Star psychiatric hospital in Anchorage, the Alaska Office of Children’s Services has been ordered by a state Superior Court judge not to keep children at the facility for indefinite periods of time.

The order is part of a preliminary injunction issued by Superior Court Judge Erin Marston that said a minor, admitted to the acute psychiatric hospital during an emergency, cannot remain there longer than 30 days without court approval.

But that length of time may change. As a next step, the judge has asked parties in the case to offer recommendations on the appropriate period of time a minor should be kept at the hospital before a court can weigh in.

The case was brought a year ago by the Southwest Alaska tribal governments of Hooper Bay and Kongiganak on behalf of the tribes’ children.

Alaska Legal Services, representing the tribes, argued that the state was improperly placing and holding children in the hospital. It provided examples of three Alaska Native teenage girls from two foster families who had been held at the hospital for at least four weeks without a judge’s approval, though their admission was based on questionable evidence.

One of the girls, a teenager referenced as C.A. for her initials, was held at the hospital for about a month, though a hearing judge later found there was no evidence supporting the decision to send her there, wrote Marston.

“OCS decided to send C.A. to North Star, although the reason for this decision is unclear,” Marston wrote.

Marston’s Feb. 12 preliminary order said that indefinite stays by children at North Star may violate U.S. constitutional rights and lead to “irreparable harm.”

“Continuing treatment of foster children without a judicial hearing raises the question of a violation of the fundamental right to due process,” he wrote.

The hospital provides a secure, locked facility where 24-hour services are given under the care of psychiatrists to children with severe emotional and behavioral disorders, he wrote.

But long, unnecessary placement at a mental hospital is not good for adolescents, said Jim Davis, the attorney arguing the case for Alaska Legal Services.

“This is not to say North Star is ‘One Flew Over the Cuckoo’s Nest,’ but a mental hospital is not a good place for kids” with typical teenage behaviors, said Davis. “It can disempower and otherwise undermine a kid’s sense of self if they don’t really have a mental illness requiring them to be there.”

North Star Behavioral Health System was a defendant in the case along with Christy Lawton, OCS director. Like OCS, North Star must change its practices because of the preliminary order, Davis said.

Officials representing and working for North Star did not return phone calls seeking comments.

Though the case is not settled, the judge’s preliminary order is in part a victory for the tribal governments.


The state’s policy was insufficient because it proposed no timeline, leaving that up to the scheduling of the courts, Davis said. Getting a hearing can take far too long, sometimes leaving a child in the mental hospital long after they should have been released, said Davis.

The girl had caused alarm after it was believed she had overdosed on antidepressants, leading to a trip to the hospital emergency room in the hub city of Bethel. There, the girl showed no physical signs of overdosing and the girl’s foster mother found the bottle of pills the next day.


D.S. was held for 38 days, while J.S. was held for 47 days, Davis said. They were released after a Superior Court judge said they shouldn’t be there, he said.

“The process isn’t working when it takes weeks and weeks to have a hearing,” Davis said.

In his order, the judge wants the parties by March 12 to recommend the appropriate length of time to hold minors before a court can weigh in.

Davis said he will argue that minors, just like adults, should not be involuntarily held longer than 72 hours without a court’s input. That is more than enough time to determine whether a minor is being improperly held at the hospital, he said.

Bookman, of the OCS, said a child admitted by a guardian is in a situation different from that of an involuntarily admitted adult, so 72 hours may not be appropriate. He said he would “talk to OCS about it, do some research and come up with a position.”

Monday, February 23, 2015

Psychiatrist Settles Pleads Guilty and Settles Civil Claims

As seen on the Illinois Nursing Home Abuse Blog


A few months ago, an Illinois psychiatrist was suspended indefinitely from practicing because of his alleged abuse of an antipsychotic drug called clozapine. Dr. Michael J. Reinstein prescribed clozapine to more than half of his patients at nursing homes as well as mental health facilities. Clozapine is used to keep patients sedated when they become irritable or violent – many of them suffer from dementia or other ailments, and antipsychotic drugs such as clozapine are used to hold them down. Such drugs can be considered an unacceptable form of chemical restraint that advocates have fought against in recent years in favor of more humane methods that avoid drug dependency.

Constant drug use by patients as prescribed can put them in a stupor and can hasten their mental and/or physical demise. Clozapine adversely affects the immune system by diminishing white blood cells, and can cause heart inflammation, seizures, and problems with the blood, as well as dizziness and lightheadedness. As we profiled earlier in this space, clozapine itself is one of the most dangerous types of antipsychotic medications, and is considered “a risky drug of last resort.” Historically, Dr. Reinstein was alleged to have prescribed more clozapine in a single year (2007) than all medical providers in the large state of Texas combined, and has had patients die in the past while on substantial doses of clozapine.

Charges, Guilty Plea and Settlement

Reinstein was also accused of taking about $350,000 in kickbacks, including gifts (like travel and dinners) from a clozapine manufacturer, Teva Pharmaceuticals, which is against the law. Teva already settled with the government over those kickback allegations. The government also sued Reinstein for taking kickbacks to prescribe clozapine, and for submitting possibly more than 140,000 false claims (overbilling) for reimbursement for these treatments from the federally funded programs Medicare and Medicaid. This type of Medicare/Medicaid fraud is prosecuted civilly and criminally under the False Claims Act, and such allegations are very serious. In recent news, Reinstein, already dealing with a suspended license and a civil suit from the government for taking kickbacks and committing medication fraud, has been charged criminally by the United States for taking kickbacks from the clozapine drug maker.

As reported by the Chicago Tribune, the criminal charges have been brought on a single kickback worth $2,000, but the government was reportedly looking to take back approximately $600,000 worth of “ill-gotten gains stemming from clozapine prescriptions.” Just days ago, Reinstein pled guilty to the federal charge of accepting kickbacks for prescribing clozapine against the Medicare and Medicaid Anti-Kickback Statute. His sentencing date is as yet unscheduled, but the please agreement includes a recommendation of 18.5 months behind bars. Along with the guilty plea, Reisnstein settled the civil case with both the Justice Department and the State of Illinois (which later joined the federal government in that suit) for $3.79 million, settling claims that he accepted kickbacks to prescribe clozapine and then submitted an astounding amount of false claims for reimbursement.


This case demonstrates the importance of cracking down on Medicare and Medicaid fraud, as well as companies and medical providers engaging in kickback schemes. This is an illegal way to “get rich” at the expense of patients who are not prescribed what they need or do not receive the appropriate treatment because doctors are prescribing medications as part of the kickback scheme. This case also highlights the abuse of federal taxpayer dollars through reimbursement claims. And above all, it puts the spotlight on the abuse of medications for chemical restraints, and how we must continue moving toward alternative methods.

"They said if I kept making noise, they would drag me into the mental-health ward and diagnose me as having mental illness."

As reported by the CBC, with much more including a video report and documentation at the link

You can also see the video here

Another case of a person being diagnosed as mentally ill for the convenience of the doctors, not to help the patient. Apparently they wanted to put here on anti-psychotics to shut her up.

Alice Zhang says she's being denied a life-saving kidney transplant because doctors at Vancouver General Hospital have decided she is mentally ill.

The 45-year-old mother of two, who speaks only Cantonese, and her family say she has no history of mental illness, and that she was only removed from the transplant list for complaining about her treatment in the hemodialysis unit.

"That's what started this whole situation" Zhang, speaking through an interpreter, told CBC Investigates.

She said doctors threatened to admit her involuntarily under the Mental Health Act.

"They said if I kept making noise, they would drag me into the mental-health ward and diagnose me as having mental illness."

Zhang said that is where she ended up on two occasions.

Polycystic kidney disease

Zhang has polycystic kidney disease. She shares custody of her boys, aged nine and 11 years old.

She needs hemodialysis three times a week, and has been on the kidney transplant list since 2009.

She said a sudden diagnosis of delusional disorder came right after she filed written complaints that nurses were too rough on her injection site.

"They said, 'Right now, we are going to temporarily stop the transplant process,'" said Zhang. Hospital documents confirm that the process was halted.

"Because I complained about them, they said that to me."

According to a psychiatrist’s handwritten notes, Zhang was paranoid.

Difficult but not delusional, says family

Zhang's husband, from whom she is separated, believes doctors are misinterpreting her actions.

"If they don't even understand what she's saying, how can they say she has a mental illness?" said Lea Kwong Chow.

"This person doesn't really have great social skills. Just because of that, you can't say they have a mental illness."

Chow said that in the nearly 20 years he has known Zhang, she has never shown any signs of paranoia.

While a translator attends most appointments, Chow and Zhang said there are many informal interactions without one.

In October, the psychiatrist's handwritten note to Zhang raised concern that she was following a nurse.

"You were asking about her last name. This was interpreted as concerning behaviour," the note said.

The notes show Zhang tried to explain she had been asked to find out the nurse's last name by her lawyer, something he confirmed in a letter to Vancouver Coastal Health.

The same psychiatrist wrote, "The fact that you believe that the nurses are trying to harm you tells me that you have a mental illness ... the nurses are starting to feel threatened by you. Some of this has to do with your complaints about them."

But Zhang — who refused to take prescribed anti-psychotic drugs — said she has never said anyone tried to hurt her on purpose.

"I have never been the suspicious type," she said. "I believe they have violated my human rights."

Sunday, February 22, 2015

Big Pharma Is America’s New Mafia

We just came across this well documented column in the Daily Beast

Here's a snippet:

“Much of what the drug industry does fulfills the criteria for organized crime in US law,” Dr. Gotzsche said in a recent interview. “And they behave in many ways like the mafia does, they corrupt everyone they can corrupt, they have bought every type of person, even including ministers of health in some countries… The drug industry buys the professors first, then chiefs of departments, then other chief physicians and so on, they don’t buy junior doctors.”

Gotzsche isn’t the only one accusing pharmaceutical companies of wrongdoing beyond the marketing malfeasance they’re famous for. In Australia, during the Vioxx class action suit brought against Merck, company emails were released revealing that Merck employees planned to “neutralize” and “discredit” doctors who criticized the drug. “We may need to seek them out and destroy them where they live,” a Merck employee wrote, according to The Australian. Apparently, uncooperative physicians were targeted to lose academic appointments and research funding for telling the truth about the negative side effects they observed.

This is troubling—but even more so in light of the fact that it’s now widely accepted that prescription drugs can be dangerous and over the years dozens have been recalled. “Our prescription drugs are the third leading cause of death after heart disease and cancer. Our drugs kill around 200,000 people in America every year, and half of these people die while they do what their doctors told them—so they die because of the side-effects,” said Dr. Gotzsche in his recent interview. “The other half die because of errors—and it’s often the doctors that make the errors because any drug may come with 20, 30 or 40 warnings, contraindications, precautions…and then the patients die.”

This is a hard pill for any of us to swallow. We should be able to trust our doctors, who should in turn be able to trust “the science.” As amusing as Oliver’s “epic takedown” of doctors was, the trouble isn’t physicians prescribing a new drug because a drug rep brings us a platter of tacos, the problem is whether the drugs we have to choose from are truly safe and effective in the first place.

Saturday, February 21, 2015

Excited Man Only Two Therapy Sessions Away From Resolving Issues [Satire]

A classic bit of Satire from the Onion on the ability (or inability) of psychiatrists to actually cure someone of anything

After over seven years of weekly meetings with his psychiatrist, 35-year-old Chris Vaughan told reporters Friday he is thrilled to be just two 45-minute sessions away from completely resolving all of his problems.

Friday, February 20, 2015

Patient at Cavan hospital given ECT without proper medication

From a Report in the Irish Times

Inspectors at a psychiatric unit in Cavan General Hospital investigated a “serious” incident where a patient was administered electro-convulsive therapy (ECT) without the required muscle relaxant medication.

An unannounced inspection was carried out at the acute psychiartirc unit of the hospital on June 3rd and 4th 2014 .

Inspection of one individual clinical file found a detained patient had consented to a course of electroconvulsive therapy treatment.

The anaesthetist failed to administer the required muscle relaxant medication before one of the treatment sessions.

The medical record stated that the patient has complained of joint stiffness and that the consultant psychiatrist would inform the patient of the drug administration error.

“However, there was no record in the patient’s clinical file that this adverse incident has been discussed with the patient,” the report said.

At the request of the inspectors, a review report in relation to the incident was provided.

Inspectors said there was no record in the of the event entered in the incident log or reviewed by all relevant clinical personnel and the manager.

“The clinical governance in response to this incident appeared to be lax” the report said.

The Inspectorate Mental Health Services immediately requested a report on the incident from the clinical director and notified the Mental Health Commission of this “matter of serious concern”.

While it is good news that ECT is on the the decline, it is shocking that not only is it still practiced in Ireland, but that they cannot even follow their own safety rules

Lawsuit describes string of sex assaults at Seattle Children's Hospital - Hospital staff failed to help girl abused in psychiatric ward

From a report in Seattle PI

Much more information at the link

A former patient at Seattle Children’s Hospital has sued, claiming hospital staff failed to notice as she was repeatedly, sexually assaulted by another patient.

Attorneys for the young woman claim at least three other children have been sexually abused at the Laurelhurst neighborhood facility in recent years. Despite assurances of reform from hospital managers, they contend too little is being done to protect children there.

Writing the court, attorneys Steve Berman and Marty McLean said their client was just one of an unknown number of children abused while locked in Children’s inpatient psychiatric unit.

“Sadly, (she) is not the first child-patient who was sexually victimized while admitted,” Berman said in the lawsuit, which was filed earlier this week. “Publically available records confirm that (she) was at least the fourth patient in a five-year span to have been sexually victimized while under (Children’s) care and custody.”

Berman, a nationally prominent attorney specializing in class-action lawsuits, went on to say he believes “there are more children who have been victimized, as well.”

A spokeswoman for Seattle Children’s declined to comment on the lawsuit. Attorneys for the University of Washington-affiliated nonprofit have not yet responded to the allegations in court.

Psychiatrist William Lewek Pleads Guilty to Hiding Matthew Straton's Body

As reported by Time Warner Cable News in Rochester, NY.

A guilty plea today from the Rochester psychiatrist accused of hiding the body of Matthew Straton in his backyard.

William Lewek, 62, pleaded guilty to tampering with physical evidence and driving while ability impaired.

Lewek was arrested in January of 2014 after investigators found the body of Matthew Straton partially buried in the backyard of his Rowley Street home. Straton dissappeared in October of 2013. Today's plea follows months of legal proceedings including an application for Lewek to enroll in a Judicial Diversion Program for drug treatment.

The trial was scheduled to begin Monday.

Big Pharma backed the Affordable Care Act, but it has bankrolled a think tank mounting the legal assault on the law

An investigative report: Big Pharma backed the Affordable Care Act, but it has bankrolled a think tank mounting the legal assault on the law, for more profits

Worth the read

Here are a couple of snippets

During the contentious battle to pass the Affordable Care Act, the pharmaceutical industry was a crucial partner of President Barack Obama. Big Pharma sank $150 million into an ad blitz promoting the Obamacare bill and spent millions lobbying for its passage. Backing health care reform was a no-brainer for the drug manufacturers; they stood to reap billions in revenues as a result of expanded health care coverage. Yet all of this makes one of Big Pharma's alliances highly curious: It has bankrolled the libertarian think tank trying to demolish Obamacare.


This was the deal Big Pharma cut during the legislative battle over Obamacare: The pharmaceutical companies agreed to support the law and accept about $80 billion in cost-cutting measures over the next decade, and the White House granted the industry lucrative concessions to protect its profit margins. These industry-favoring measures include provisions preventing the government from negotiating lower drug prices for Medicare and Medicaid and blocking Americans from importing cheaper prescription drugs from abroad. Those concessions were costly to taxpayers and consumers, but they were part of the grand bargain hammered out between the White House and Big Pharma. This accord ensured the industry would use its formidable lobbying clout to pass Obamacare—not destroy it.

Thursday, February 19, 2015

Third patient death in 13 months at boutique psychiatric rehab center Sierra Tucson

From an extended report from the Arizona Daily Star

Sounds like this boutique psychiatric center for the well to do has a history of grabbing for the money and cutting corners for fun and profit.

Many more details at the link

A third patient in 13 months has died while in treatment at the Sierra Tucson center north of Tucson, an autopsy report says.

The report from the Pinal County Medical Examiner’s Office released last week says a 55-year-old Pennsylvania man hanged himself with a belt in his room at Sierra Tucson on Jan. 23.

According to the report, the man had been on suicide watch and he left a suicide note inside a tote bag next to his bed. Witnesses told investigators that he was discovered in his room, “unconscious but still breathing,” two hours after staff began looking for him, the report says.

The suicide is the third patient death at Sierra Tucson since January 2014 and the fourth since August 2011.

Autopsies determined two of the patient deaths to be suicides and two as undetermined. The deceased patients, all male, ranged in age from 20 to 71.


The upscale, nationally known Sierra Tucson facility is situated on a 160-acre site at 39580 S. Lago del Oro Parkway along the Pinal/Pima County border. It has 124 beds, plus 15 acute level beds.

In the latest case a married father of two, who had checked into Sierra Tucson on Jan. 4 for severe depression and chronic pain due to neuropathy, was found dead in his room at 12:41 p.m. Jan. 23.


The facility has programs to help patients with addictions, mood disorders, chronic pain, eating disorders and trauma through its “Sierra Model” of integrating therapies such as massage, yoga and acupuncture with traditional psychiatry. Most patients are in their late 30s and early 40s. A majority of patients self-pay at a cost of about $1,300 per day.


The state has reprimanded Sierra Tucson numerous times since 2009 for failing to follow its own policies on patient care

Wednesday, February 18, 2015

Jurors to decide fate of South Florida psychiatrist, others in Medicare fraud trial

Highlights from an extended report in the Miami Herald

Barry Kaplowitz was a psychiatrist with a “robotic” signature who signed off on thousands of bogus treatments at a Hollywood psychiatric facility that bilked Medicare for millions — even when he was out of the country, prosecutors say.

“It’s not just any kind of signing; it’s robo-signing,” Justice Department prosecutor Andrew Warren declared during closing arguments at his Miami federal trial.


On Tuesday, Miami federal jurors resumed deliberating the fate of Kaplowitz, 54, an Aventura psychiatrist who worked part-time as the medical director of Hollywood Pavilion’s outpatient facility, and two other defendants on charges of conspiring to defraud Medicare and related offenses.


The other defendants are Melvin Hunter, 63, a Broward resident who worked as an admissions supervisor for Hollywood Pavilion’s inpatient facility, and Tiffany Foster, 49, an Alabama resident accused of taking bribes to refer mental health patients.

A fourth defendant, Christopher Gabel, 62, of Davie, the former chief operating officer, pleaded guilty in November to conspiring to commit healthcare fraud and pay kickbacks to patient recruiters. Gabel, who is serving a six-year prison term, testified that Medicare beneficiaries — including drug addicts with disability status — were admitted regardless of whether they qualified for treatment or even saw a doctor.

The latest trial followed the 2013 conviction of Hollywood Pavilion's chief executive officer, Karen Kallen-Zury, of Lighthouse Point, who was found guilty along with three other employees of conspiring to bilk $67 million from Medicare by filing phony claims for mental health services from 2003 to 2012. Medicare was tricked into paying $40 million to Hollywood Pavilion. Of those defendants, Kallen-Zury received the longest sentence: 25 years.

During the six-week trial, prosecutors presented evidence showing that Kaplowitz generated $6.5 million in false claims for Medicare patients who did not need psychiatric treatment, resulting in $3 million in tainted income for Hollywood Pavilion between 2008 and 2011. The psychiatrist was paid $1,250 a month over that period for showing up one day a week to sign charts and other paperwork to justify 2,800 false claims to Medicare, prosecutors said.


The prosecution of Kaplowitz, Hunter and Foster was the latest crackdown by the Justice Department and U.S. attorney's office against operators of mental-health facilities accused of fleecing the Medicare program.

Three previous major prosecutions led to the convictions of about 100 clinic operators, doctors, therapists and patient recruiters at American Therapeutic, Biscayne Milieu and Health Care Solutions Network in South Florida.

Several of those convicted defendants testified at the latest trial. Among them: Dr. Alan Gumer, a former medical director at the Hollywood Pavilion facility who is serving a 21/2-year sentence in the American Therapeutic case, and Keith Humes, a Hollywood Pavilion patient recruiter who is serving a seven-year prison sentence stemming from another Medicare fraud offense.

Tuesday, February 17, 2015

Psychiatrist Dr. Francisco J. Pages Called 'Clueless' About Drugs

As reported by WUSF News

Another corrupt shrink on the drug company payroll

A long-time Miami-area psychiatrist who prescribes heavy-duty drugs in abundance has not been doing it safely, the Florida Board of Medicine said Friday.

Dr. Francisco J. Pages, charged with mismanaging the care of nine patients, needs to be evaluated to see what his knowledge level is, the board decided at a meeting in Stuart. Pages needs training to make up the deficits and close supervision by another psychiatrist for at least two years, the board said.

“I’m not sure this physician understands the multiple medications he’s prescribing,” said board member Dr. Bernardo Fernandez of Coral Gables. “Some of these patients are on seven, even 10 medications. Sometimes he prescribes a medication that counteracts the medications (the patient is) already on.”

Dr. Zach Zachariah of Fort Lauderdale pulled no punches. “If you look at this case, it portrays a physician who is clueless, absolutely clueless,” he said.

Pages said very little, leaving that to his attorney.

“Uninsured, homeless citizens rely on Dr. Pages. He sees the patients no one else truly wants to see,” the lawyer, Philip Goss, said.

Goss said that while his client was “embarrassed” to be called before the Board of Medicine, he sees his problems not as lack of skill but as “improper record-keeping and lack of attention to detail.”

The Board of Medicine didn’t buy it. “It’s not inattention to detail,” said Dr. Sarvam TerKonda of Jacksonville. “It’s inappropriate prescribing.”

Regardless of their status, patients deserve the proper medicine, said Dr. Fernandez.


The board rejected a settlement negotiated between Pages and the Florida Department of Health as being insufficient. To the original terms -- a reprimand, $25,000 fine, some courses and two years’ probation – the board added an evaluation of Pages’ skills by a special team from University of Florida.

Technically, the psychiatrist could reject that offer and insist on a formal hearing, but attorney Goss said after the hearing that Pages would probably accept it.

The psychiatrist, who used to have an office, now practices only in hospitals, Goss said. He did not say which ones. The state DOH web site lists him as having privileges at six hospitals, but the list is clearly out of date since one of them has closed.

Pages was reported to DOH by the state Agency for Health Care Administration after his Medicaid prescribing patterns caused alarm, state records show. Pages lost the right to participate in the Medicaid program.

But not Medicare. Pages showed up as a fairly prolific prescriber for Medicare patients in ProPublica’s "Dollars for Docs” project, in which reporters analyzed the prescriptions filled for Medicare patients in 2012. ProPublica's searchable database shows Pages was responsible for about 15,000 claims for about 1,000 patients at a cost of $3 million. Among Florida psychiatrists, some wrote more prescriptions, but only one cost taxpayers more.

Pages is among the doctors who received money as a consultant for pharmaceutical companies, according to the ProPublica database. His two largest benefactors were Eli Lilly, which paid him about $20,000 for speaking in 2009-10, and Pfizer, from which he received about $16,000 in 2010 and smaller amounts in recent years, since the state investigation of his prescribing patterns began.

Monday, February 16, 2015

Man sentenced to 17 years in prison for childmolestation of his own daughter. Judge outraged at the man's psychiatrist

As reported in the Daily Telegraph

The Judge in the case had especially harsh words for the psychiatrist assigned to the case.

A truck driver will spend at least 17 years in jail for the sexual abuse of his daughter in one of the longest sentences handed down to a paedophile father in Australia.

In sentencing the 49-year-old man, who cannot be named to protect the identity of his daughter, Judge Paul Conlon said it was what the community expected.


Judge Conlon, who has a ­reputation for handing down tough sentences to child sex offenders, said the truck driver had exploited her youth “in the worst possible way”.

“He has groomed his own daughter, turning her into his sexual play thing,” the judge said.

He was critical of psychiatrist Dr Olav Nielssen who told the court the repeated sexual abuse over seven years had been “opportunistic”.

Judge Conlon said the psychiatrist had seemed to treat “without any critical evaluation” the man’s comments that he had trouble “showing his feelings” to his daughter and had not known how to express himself.

“In my view, it is inappropriate to use the word ‘opportunistic’ when dealing with persistent sexual abuse of a child over a period of seven years. I am unable to have much confidence in this future risk assessment,” Judge Conlon said.

His daughter, now 28, went to Queensland police in 2007. The ­father was sentenced in Queensland to a maximum of four years with a non-parole term of just one year four months after telling the psychiatrist that “he and his daughter had a very close and open relationship and that he really loved her”.

He had pleaded guilty to three counts of raping his daughter.


Psychiatrist Tanveer Ahmed sacked by the Australian over new plagiarism allegation

As reported in the Guardian

Many more details at the story link

The psychiatrist and columnist Tanveer Ahmed has been sacked by the Australian for plagiarism – just two years after being dropped by the Sydney Morning Herald for a series of similar cases.

Ahmed was exposed by ABC TV’s Media Watch in 2012 and consequently lost his regular spot as a commentator for Fairfax Media.

On Monday the blogger Ketan Joshi accused Ahmed on Twitter of plagiarising the US political website Prospect in his latest article for the Australian, a controversial opinion piece on domestic violence.

The editor of the Australian, Clive Mathieson, told Guardian Australia he became aware of the accusation on Monday.

“When the Australian discovered it, we discussed it with Tanveer Ahmed and it was decided he would no longer be writing for us,” Mathieson said.

Friday, February 13, 2015

Chicago psychiatrist pleads guilty to taking drug kickbacks

As reported by ABC channel 7 in Chicago

A long-time Chicago psychiatrist pleaded guilty Friday to receiving illegal kickbacks and benefits totaling nearly $600,000 from pharmaceutical companies in exchange for prescribing an anti-psychotic drug to his patients.

Dr. Michael J. Reinstein, 71, of Skokie, has also agreed to pay $3.79 million to settle a civil lawsuit alleging that he caused the submission of at least 140,000 false Medicare and Medicaid claims for the thousands of patients he prescribed Clozapine to in nursing homes and other facilities in exchange for kickbacks.

"The defendant put his patients at great risk of serious health problems to benefit his personal interests at taxpayer expense," said Attorney General Lisa Madigan, whose office handled the civil litigation.

Reinstein's plea agreement calls for the government to recommend a sentence of 18.5 months in prison when he is sentenced.

Thursday, February 12, 2015

Monroeville psychiatrist charged with billing Medicaid while license suspended

As reported by eTrib Live

A Monroeville psychiatrist accused of Medicaid fraud, theft and delivery of controlled substances had lost his license through Pennsylvania and Ohio suspensions.

The state attorney general's office on Thursday charged Jopindar P. Harika, 61, with more than 100 counts of Medicaid fraud, attempted Medicaid fraud, theft by deception, tampering with public records, delivery of a controlled substance and unlawful prescribing.

“I'm confident that once he has his day in court, we will be able to prevail in these charges,” said Jan Ira Medoff, Harika's attorney. “These are just allegations.”

Harika told a grand jury he was aware his license was suspended for 32 days in 2012 because of unpaid child support in Allegheny County when he is alleged to have seen 565 patients and written prescriptions for at least 453 patients at three mental health agencies in Philadelphia and Berks County.

According to the grand jury presentment, “Harika gave a variety of excuses as to why he continued to practice medicine when he knew that his license was suspended.”

Many of the clients that Harika reported seeing were not billed to Medicaid, but according to the presentment, Harika did bill $59,000 to Medicaid through three agencies: Multicultural Wellness Center in Philadelphia and Reading Behavioral Health Services and Child and Family Support Services in Reading.

The agencies paid him $73,380 in salary.

Administrators from the three facilities said they fired Harika at varying points in 2013.

Multicultural returned $135,000 in fraudulent billing based upon Harika's suspended medical license.

“A doctor's mission should be to provide the best treatment possible for patients, not exploit them to make money,” Attorney General Kathleen Kane said.

Harika is free on $25,000 bond.

According to a report from the State Medical Board of Ohio, Harika's problems began with a 1997 theft charge to which he pleaded guilty. The report stated that Harika billed Somerset State Hospital and Pennsylvania for medical services he did not provide. In 1999, he was sentenced to four years of probation, ordered to pay $84,609 in restitution to Pennsylvania and provide free treatment to mental health patients during the first two years or his probation.

Ohio suspended Harika's license to practice for at least two years; the Pennsylvania State Board of Medicine suspended his license for two months, fined him $700 and put him on probation.

Wednesday, February 11, 2015

The U.S. Attorney for the Northern District of Illinois filed a single felony charge against Dr. Michael Reinstein, a Chicago psychiatrist took kickbacks for prescribing an antipsychotic drug

As reported on ProPublica

Be sure to the original for many extar links related to the story

A former Chicago psychiatrist who was the nation's top prescriber of the most powerful and riskiest antipsychotic drug intends to plead guilty to a federal felony charge of taking kickbacks from its manufacturer in exchange for prescriptions, court records show.

The U.S. Attorney for the Northern District of Illinois filed a single felony charge against Dr. Michael Reinstein this week for taking $2,000 in November 2009 from drugmaker Teva "in return for Reinstein's referrals of patients" for clozapine prescriptions.

Clozapine, also known as Clozaril and FazaClo, is approved to treat schizophrenia patients who don't respond to other medications. But it can have dangerous side effects, including seizures, inflammation of the heart muscle, and a drop in white blood cells. The drug is considered particularly risky for elderly patients.

A note in court records says that Reinstein intends to plead guilty at his arraignment next Friday. The action was first reported by the Chicago Tribune.

Reinstein's prescribing patterns have been detailed in two ProPublica reports.

In 2009, ProPublica and the Chicago Tribune reported how in one year Reinstein prescribed more of the antipsychotic clozapine to patients in Medicaid's Illinois program than all doctors in the Medicaid programs of Texas, Florida and North Carolina combined. Autopsy and court records showed that at least three patients under Reinstein's care had died of clozapine intoxication. At that time, Reinstein defended his prescription record, arguing that clozapine is effective and underprescribed.

Then, in 2013, as part of a ProPublica investigation into Medicare's failure to monitor problem prescribers, we reported that Reinstein prescribed even more clozapine in Medicare's prescription drug program for seniors and the disabled. Medicare continued to let him prescribe in the program even after the U.S. Department of Justice accused him of fraud and Illinois' Medicaid program suspended payments to him.

The U.S. Attorney's office declined to discuss Reinstein's upcoming plea. Reinstein's attorney, Terence Campbell, did not immediately return a phone call from ProPublica seeking comment. He told the Tribune on Thursday that Reinstein was "working toward resolving the issues raised by the government and hopes to put this episode behind him soon."

The Tribune reached Reinstein, as well, yesterday. He would not discuss the criminal case but denied any payments from Teva, clozapine's manufacturer, were for prescribing the drug. The doctor instead said the money was for lectures he gave.

In November 2012, the federal government filed a civil fraud lawsuit against Reinstein, saying he "received illegal kickbacks from pharmaceutical companies and submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he prescribed for thousands of mentally ill patients in area nursing homes."

Last August, Illinois medical regulators indefinitely suspended Reinstein's medical license after determining that Reinstein received " illegal direct and indirect remuneration" from the maker of generic clozapine, did not consider alternative treatments for his patients, and disregarded patients' well-being. In response to the medical board's accusations, Reinstein's lawyers invoked his right against self-incrimination.

Early last year, Teva Pharmaceutical Industries Ltd., the maker of generic clozapine, agreed to pay more than $27.6 million to settle state and federal allegations that it induced Reinstein to prescribe the drug.

Reinstein's prescribing of clozapine appears to have declined after our 2009 articles about him. From 2007 to 2009, he wrote an average of 20,000 Medicare prescriptions annually for clozapine and the brand-name version, FazaClo. That figure dropped to about 8,000 in 2012, according to data obtained by ProPublica.

Tuesday, February 10, 2015

In 2013 The Wall Street Journal discovered a cache of files that revealed the U.S. government lobotomized over 2000 veterans against their will after WW2.

The veterans were lobotomized for reasons such as PTSD, depression, schizophrenia, and occasionally homosexuality.

Here is the Link to Part 1 of this important investigation: The Lobotomy Files

Here is the introduction to this important story

Roman Tritz’s memories of the past six decades are blurred by age and delusion. But one thing he remembers clearly is the fight he put up the day the orderlies came for him.

“They got the notion they were going to come to give me a lobotomy,” says Mr. Tritz, a World War II bomber pilot. “To hell with them.”

The orderlies at the veterans hospital pinned Mr. Tritz to the floor, he recalls. He fought so hard that eventually they gave up. But the orderlies came for him again on Wednesday, July 1, 1953, a few weeks before his 30th birthday.

This time, the doctors got their way.

The U.S. government lobotomized roughly 2,000 mentally ill veterans—and likely hundreds more—during and after World War II, according to a cache of forgotten memos, letters and government reports unearthed by The Wall Street Journal. Besieged by psychologically damaged troops returning from the battlefields of North Africa, Europe and the Pacific, the Veterans Administration performed the brain-altering operation on former servicemen it diagnosed as depressives, psychotics and schizophrenics, and occasionally on people identified as homosexuals.

The VA doctors considered themselves conservative in using lobotomy. Nevertheless, desperate for effective psychiatric treatments, they carried out the surgery at VA hospitals spanning the country, from Oregon to Massachusetts, Alabama to South Dakota. Roman Tritz talks about the scars from his lobotomy.

The VA’s practice, described in depth here for the first time, sometimes brought veterans relief from their inner demons. Often, however, the surgery left them little more than overgrown children, unable to care for themselves. Many suffered seizures, amnesia and loss of motor skills. Some died from the operation itself.

Doylestown Psychiatrist Basem Shlewiet Sentenced to Prison for Fondling Patients

As seen in the Doylestown-Buckingham-New Britain Patch

A Doylestown psychiatrist convicted of fondling seven female patients during treatment will serve seven to 17 years in state prison.

Basem Shlewiet, 43, a Buckingham resident, was sentenced Monday by Judge Wallace H. Bateman,

In October, a jury found Shlewiet guilty of 16 of 18 criminal counts, including indecent assault and unlawful conduct with a minor.

Shlewiet was arrested in late 2014 after a nine-month investigation that began when Doylestown Borough Police received reports from women who said they had been touched in a sexual way during treatment at Shlewiet’s North Franklin Street office.

Initially, two of the victims told authorities that Shlewiet touched their breasts and another victim, who was 17 at the time, told authorities he touched her vaginal area. After his arrest, five more victims came forward saying Shlewiet had also inappropriately touched them.

The week-long trial included testimony from former patients, coworkers and character witnesses.

Shlewiet was represented by defense attorney Louis Busico.

Is your doctor is getting paid by a pharma company? Look It up here

Using the Open Payments website you can research if your doctor is receiving payments from various drug companies. You can also look up other data by company name and by teaching hospital. USA only.

Here's the link

Obligatory disclaimer
This search tool only searches identified data. The datasets are large and the search tool searches millions of records. For some searches the results will take some time to load, please be patient.

Data is reported on this website in accordance with the statutory authority in Section 1128 G of the Social Security Act. CMS has an impartial role in the collection and reporting of data regarding payments or other transfers of value pursuant to Open Payments. The transparency display of transactions from applicable manufacturers and group purchasing organizations to physicians and teaching hospitals does not necessarily mean any of the reported financial relationships are improper.

See our earlier post on this topic

Monday, February 09, 2015

"Pharmaceutical money: Ask your doctor if his taking it is right for you."

Courtesy of Alternet

VIDEO: John Oliver Eviscerates the Stunningly Corrupt Practices of Big Pharma

John Oliver dug deep into the corrupt practices of the pharmaceutical industry in a 17-minute rant Sunday that will be one for the ages.

It's a must-watch video tha lays bare just how deeply invested Big Pharma is in getting doctors to prescribe their drugs to millions of people, no matter what. In fact, Oliver explains, Big Pharma spends much more on marketing to doctors than it does on research, or to marketing to us in television advertising. Why? Because we tend to trust our doctors. And if they say take this pill, we will.

Amidst the really alarming facts in Oliver's careful dissection of the issue are some pretty hilarious lines. At one point the HBO comedian compares drug compaines to high school boyfriends: "They're much more interested in getting inside you than in being effective once they are there."

There have been tiny glimmers of reform in Big Pharma's dishonest practices: Pharmaceutical reps are not allowed to take doctors out for lavish meals all the time, now. And the Affordable Care Act has helped set up a website which enables you to look up whose money your doctor is taking.

Saturday, February 07, 2015

‘Darwinian’ test uncovers an antidepressant’s hidden toxicity.

Rodent study finds that exposure to an antidepressant in womb or in youth can cause lifetime decline in sexual behavior, body weight, and competitive ability.

Once you strip away the scientific verbiage, it becomes obvious that the prolonged use of these drugs creates generations of "losers".

As reported on Science Daily
Because of undetected toxicity problems, about a third of prescription drugs approved in the U.S. are withdrawn from the market or require added warning labels limiting their use. An exceptionally sensitive toxicity test invented at the University of Utah could make it possible to uncover more of these dangerous side effects early in pharmaceutical development so that fewer patients are given unsafe drugs.

To prove the point, the U researchers ran their test on Paxil, an antidepressant that thousands of pregnant women used in the years before it was linked to an increased risk of birth defects. The U.S. Food and Drug Administration now requires a warning about use in the first trimester of pregnancy. In the U study, mice exposed during development experienced multiple problems: males weighed less, had fewer offspring, dominated fewer territories and died at a higher rate. Females took longer to produce their first litters, had fewer pups and pups that were underweight. The drug doses were relatively close to those prescribed for people. In the conventional animal safety testing reported by the drug's manufacturer, no reproductive side effects emerged until rodents took doses multiple times higher than those given to treat depression.

"We are seeing effects at a dose that is close to human levels. And we are doing it exactly the way we need to determine if it presents a risk of harm to a developing fetus," says University of Utah biologist Shannon M. Gaukler, the study's lead author who recently completed a doctoral degree at the U. The study will be published in the January-February issue of Neurotoxicology and Teratology, which has posted a preprint online.


Testing Paxil

In the Paxil study, the researchers gave food laced with the antidepressant to 20 breeding pairs of mice for several weeks, until all had produced up to four litters. Doses were equivalent to about 1.8 times the level typically prescribed for people. The offspring also ate Paxil-laced chow until they reached breeding age. The researchers then released the exposed offspring into the competitive arena with the offspring of a control group of mice never exposed to Paxil. Groups consisted of eight males and 14 to 16 females, creating population densities comparable to those seen in the wild. The researchers started five such populations and kept them going for six months.

Males exposed to Paxil were about half as likely to control a territory. They also lagged behind control males in body weight throughout the weeks of competition and were more likely to die. Exposed males produced 44 percent fewer offspring. Exposed females showed no significant weight or mortality differences, but they produced half as many offspring as control females at the initial assessment. Their fecundity rebounded at later time points.

Thursday, February 05, 2015

A proposed settlement in the class action lawsuit vs psychiatric facilities SLS Residential Inc., SLS Health, Inc., SLS Wellness, Inc., Supervised Lifestyles, Inc. in the state of New York

As seen in this PDF from the website of Sussman & Watkins

An important point is that it is highly recommended that any claims be submitted by the end of next week, the 13th of February 2015

NOTICE OF CLASS ACTION SETTLEMENT (Romano, et al. v. SLS Residential, Inc., et al.; No. 07cv2034 (MHD))

A proposed settlement has been reached between the plaintiff class and the SLS defendants in this class action lawsuit.

You are receiving this notice and the attached Claims Form because you were previously identified as a member of the class. The terms of the proposed settlement are as follows:

• A total Settlement Amount of $3,000,000 (Three Million Dollars) distributed as follows:
• Payment of a total of $1,929,000 to 269 class members. Individual awards are based on length of stay at SLS during the class period (July 1, 2004 - May 31, 2006).
• Payment of $108,000 in service awards to class member deponents;
• Payment of $150,000 service/incentive award to the class representative;
• Payment of $740,000 in attorneys' fees to Sussman & Watkins;
• Payment of $58,500 to Sussman & Watkins for out-of-pocket costs;
• Reserve fund of $14,500.

There are 269 class members. Individual settlement awards range from $500 to $17,000. The amount you receive is based on the length of time you were at SLS client during the class period of July 2004-May 2006. In addition, more weight has been given for periods in which class members resided in the Multicare houses or PAT townhouses than for time spent in the SDL apartments or Case Management. A copy of the Settlement Agreement and the plaintiffs' legal brief requesting that the Court approve the Settlement is available at the website of Sussman & Watkins, which is
To the extent that any of the 269 class members exclude themselves from this settlement or do not submit claims forms after the final deadline, their unclaimed settlement awards will be aggregated and distributed to the remaining class members. That means that you may receive a second payment several months after the first, but the size of that payment will not be able to be determined until after the final deadline for submitting claims forms.

For instructions on submitting a claim, or if you want to object to, or exclude yourself from, this proposed settlement, [...] (or) For all questions about the Settlement, you may contact Class Counsel at:

Sussman & Watkins
PO Box 1005
1 Railroad Ave.
Goshen, NY 10924
(845) 294-3991
Michael Sussman:
Christopher Watkins:

Once you have completed the Claims Form, mail it back to Sussman & Watkins. The initial deadline to mail back your Claims Form is February 13, 2015. There will be a second chance for Class Members to submit Claims Forms after the Court gives final approval of the settlement, but you should get your Claims Form in now to avoid any problems regarding your claim. If you lose or misplace your Claims Form, you should contact Sussman & Watkins for a new one.

Timing of Settlement Payments: The settlement funds will be distributed within thirty days or so after the Court has given its final approval of the settlement. Currently, the Fairness Hearing for the judge to make that determination is scheduled for February 24, 2015 at 10:00 a.m., but it may be adjourned or continued. You can check the website of Sussman & Watkins ( for updates regarding the status of the settlement, including notification of when the judge has given final approval of the settlement and the anticipated date settlement awards will be mailed to class members who submitted Claims Forms
As seen here (PDF) New York State had ordered Putnam mental-health company SLS to giveup permits to operate
The state has ordered a private Putnam County-based mental-health provider that treats teens and young adults to surrender its operating certificates after the mental-health commissioner upheld charges that the for-profit facility violated patients' rights and ignored state regulations.
More information here on the fallout from the state shutdown
A Putnam County-based, for-profit mental health provider that treats teens and young adults lost its latest legal battle when an appellate court upheld the state mental health commissioner's decision to revoke its operating certificates because it violated patients' rights and ignored state regulations.

The state OMH is already moving toward shutting down the 20-year-old company.

"We are gratified by the decision of the Appellate Division, Second Department, which unanimously upheld the (OMH) commissioner's final determination revoking all three operating certificates," Leesa Rademacher said in a statement. "OMH will immediately begin working cooperatively with SLS to (ensure) that all patients currently being served by the programs will be transitioned to appropriate care settings."


Pleasantville resident Glen Feinberg, an attorney who has alleged his son received abusive treatment while an SLS patient, said he does not think it can successfully appeal the latest ruling.

"The courts are not likely to overturn the unanimous ruling upholding OMH's determination that SLS lacks the character and competence to operate a licensed facility in New York state," Feinberg wrote in an email Tuesday.

Wednesday, February 04, 2015

Iowa's Governor Terry Branstad seeks to close two mental institutes

From a much longer report at the Des Moines Register

Gov. Terry Branstad has proposed closing two of the state's four institutes for people with mental illnesses.

The proposal startled legislators of both parties, although the idea of closing at least one of the institutes has been debated off and on for decades, as their populations dwindled and costs soared.


Branstad suggested during a budget hearing last month that he wanted to consider consolidating some of the services at the institutions. "The facilities are obsolete, and it's extremely expensive" to use them the way the state now does, he said then. However, he said he had no immediate plans to do so.

According to his new budget, however, Branstad wants to zero out spending for the Mount Pleasant and Clarinda institutions. According to the budget, the state is spending nearly $7 million on the Mount Pleasant facility this budget year and $8.7 million on the Clarinda facility.
Local legislators were surprised by the Governor's budget proposals, and are in a panic over the proposed closings

Alabama Psychiatric Services to close all offices Feb. 13

Edited from a Report on

Alabama Psychiatric Services will close all locations across the state by Feb. 13, according to Richard Craig, executive director of the Jefferson, Blount, St. Clair Counties Mental Health Authority.

Craig said employees at his agency have been working with insurance providers to find new care for patients treated at facilities run by Alabama Psychiatric Services.

The company has locations in Birmingham, Cullman, Decatur, Dothan, Fairhope, Florence, Madison, Mobile, Montgomery and Tuscaloosa, according to the website.

Executives from the company have not returned calls seeking comment, but a receptionist at one office confirmed that they were no longer taking new patients.


An employee at the clinic told Allen that they found out just yesterday that the facility would be closing on Feb. 13. Allen had not heard anything about the closing.


Executives at Alabama Psychiatric Services notified Blue Cross Blue Shield on Friday that they were closing all their offices across the state, wrote spokeswoman Koko Mackin in an email.

"Blue Cross is working diligently to minimize any inconvenience these office closures may cause for our members and their families," Mackin wrote. "We are disappointed about these closures and are doing everything we can to assist our members during this transition."

Craig said he didn't know how the closure will affect access to mental health care in Alabama.


Tuesday, February 03, 2015

Psychiatric Misdiagnosis Due To Cultural Differences

As seen in this recent article at


Interpreting language is complex, and many things can get in the way of effective communications, says Price-Wise. First, many people don’t know much about physiology and anatomy. It’s difficult to communicate what’s not well understood by the patient or interpreter. Second, the interpreter must be able to remember what the patient said, and the patient may have taken quite a bit of time to describe his or her problems. Third, the interpreter may give a summary of what he or she thought was important and, unwittingly, leave out clinically-relevant information; alternatively, the interpreter may decide not to relay information, because it’s embarrassing, or the interpreter may not relay information from the doctor to the patient to avoid upsetting the patient. Untrained interpreters may also add their own opinions. These errors and omissions can impact a diagnosis or treatment plan, Price-Wise notes. Trained interpreters, on the other hand, have the same conversation as if they spoke the same language, Price-Wise says.

Further complicating communications are false cognates, words that sound alike in two languages but have different meanings. For example, “embarrasada” in Spanish means pregnant, not “embarrassed.”

Price-Wise also broached a case in which a teenager who arrived in the emergency room was treated for a drug overdose, because his family believed he had food poisoning, “intoxicado,” in Spanish. In fact, he had a brain hemorrhage that was overlooked as a result of the misinterpretation of a word that sounded like “intoxicated.” He was left a quadriplegic.


“Our work suggests that, in African Americans compared with both Latino and non-Latino whites, clinicians excessively weight psychotic symptoms…in African-Americans as the expense of mood and anxiety symptoms during clinical assessments, leading to an erroneous conclusion of schizophrenia in the former,” says Stephen M. Strakowski, a professor of psychiatry and behavioral neuroscience, psychology, and biomedical engineering at the University of Cincinnati College of Medicine.

Strakowski points out that hallucinations, delusions, and thought disorders are not disease specific. They can occur as a result of a brain tumor, stroke, or infection, among other non-psychiatric conditions, or drug abuse, depression, post traumatic stress disorder (PTSD), bipolar disorder, or schizophrenia, among others.

“Schizophrenia is not supposed to be diagnosed until other causes of psychosis are ruled out,” Strakowski says.

Strakowski says the reasons for the overweighting are not known, but he thinks it could be that clinicians are misinterpreting distrust of doctors among African Americans as paranoia, or clinicians may be missing the symptoms of PTSD, which, Strakowski says, can mimic psychotic symptoms. He also thinks it’s possible that it could result from a delay among African Americans in getting treatment so that they are more ill on presentation. Or, it may be due to a failure among clinicians to understand the cultural differences in idioms of distress with regard to mood symptoms.


Monday, February 02, 2015

Choosing Wisely: Five Things Physicians, Psychiatrists, and Patients Should Question

As seen on the Choosing Wisely website

Available also as a PDF

1 Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.

Metabolic, neuromuscular and cardiovascular side effects are common in patients receiving antipsychotic medications for any indication, so thorough initial evaluation to ensure that their use is clinically warranted, and ongoing monitoring to ensure that side effects are identified, are essential. “Appropriate initial evaluation” includes the following: (a) thorough assessment of possible underlying causes of target symptoms including general medical, psychiatric, environmental or psychosocial problems; (b) consideration of general medical conditions; and (c) assessment of family history of general medical conditions, especially of metabolic and cardiovascular disorders. “Appropriate ongoing monitoring” includes re-evaluation and documentation of dose, efficacy and adverse effects; and targeted assessment, including assessment of movement disorder or neurological symptoms; weight, waist circumference and/or BMI; blood pressure; heart rate; blood glucose level; and lipid profile at periodic intervals.

2 Don’t routinely prescribe two or more antipsychotic medications concurrently.

Research shows that use of two or more antipsychotic medications occurs in 4 to 35% of outpatients and 30 to 50% of inpatients. However, evidence for the efficacy and safety of using multiple antipsychotic medications is limited, and risk for drug interactions, noncompliance and medication errors is increased. Generally, the use of two or more antipsychotic medications concurrently should be avoided except in cases of three failed trials of monotherapy, which included one failed trial of Clozapine where possible, or where a second antipsychotic medication is added with a plan to cross-taper to monotherapy.

3 Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.

Behavioral and psychological symptoms of dementia are defined as the non-cognitive symptoms and behaviors, including agitation or aggression, anxiety, irritability, depression, apathy and psychosis. Evidence shows that risks (e.g., cerebrovascular effects, mortality, parkinsonism or extrapyramidal signs, sedation, confusion and other cognitive disturbances, and increased body weight) tend to outweigh the potential benefits of antipsychotic medications in this population. Clinicians should limit the use of antipsychotic medications to cases where non-pharmacologic measures have failed and the patients’ symptoms may create a threat to themselves or others. This item is also included in the American Geriatric Society’s list of recommendations for “Choosing Wisely.”

4 Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.

There is inadequate evidence for the efficacy of antipsychotic medications to treat insomnia (primary or due to another psychiatric or medical condition), with the few studies that do exist showing mixed results.

5 Don’t routinely prescribe an antipsychotic medication to treat behavioral and emotional symptoms of childhood mental disorders in the absence of approved or evidence supported indications.

There are both on and off label clinical indications for antipsychotic use in children and adolescents. FDA approved and/or evidence supported indications for antipsychotic medications in children and adolescents include psychotic disorders, bipolar disorder, tic disorders, and severe irritability in children with autism spectrum disorders; there is increasing evidence that antipsychotic medication may be useful for some disruptive behavior disorders. Children and adolescents should be prescribed antipsychotic medications only after having had a careful diagnostic assessment with attention to comorbid medical conditions and a review of the patient’s prior treatments. Efforts should be made to combine both evidence-based pharmacological and psychosocial interventions and support. Limited availability of evidence based psychosocial interventions may make it difficult for every child to receive this ideal combination. Discussion of potential risks and benefits of medication treatment with the child and their guardian is critical. A short and long term treatment and monitoring plan to assess outcome, side effects, metabolic status and discontinuation, if appropriate, is also critical. The evidence base for use of atypical antipsychotics in preschool and younger children is limited and therefore further caution is warranted in prescribing in this population.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

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