Paul Corona, 'Guru' doctor of mood-stabilizing drugs on probation for second time

From the Orange County Register

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.

Poor treatment at Lehigh Valley mental health clinics was evident, patients say

From a longer report in the Lehigh Valley Live website

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.

[...]

The Hoffman Report: The Investigation into the American Psychological Association (APA)

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.”

Also,

“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)

California suspends license for Fairfield psychiatrist

From a much larger report in the Daily Republic

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.

Woman tells of 'hell on earth' at Limerick psychiatric unit

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."

Recruitment for Psychiatric Treatment Trials: An Ethical Investigation

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

• minimization of risk;
• euphemism;
• 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 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.

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.

My Trip Through the Polypharmacy Blender

A long story by Rory Tennes on the Risx website, describing his descent into psychiatric hell.

We only present a few snippets, and recommend reading the full article.

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.

[...]

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 www.sussmanwatkinslaw.com
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: sussmanl@frontiernet.net
Christopher Watkins: chris_sussmanl@frontiernet.net

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 (www.sussmanwatkinslaw.com) 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.

Medical malpractice is not limited to surgery, and the case of Paul Lozano illustrates this better than any other example.

Item #2 from the List Verse Article 10 Horrible Cases Of Medical Malpractice

Medical malpractice is not limited to surgery, and the case of Paul Lozano illustrates this better than any other example. Lozano had been sexually abused by his mother as a child, and his psychiatrist, Margaret Bean-Bayog, decided to try a form of therapy known as “reparenting”, where the psychiatrist simulates the different stages of lifespan development in an attempt to “reprogram” the patient. She coddled him, read him stories, called him “baby”, made him call her “mother”, and made him learn cue-cards off by heart. One such card read “I’m your mom and I love you and you love me very much. Say that 10 times”. Other cards were more sexual, and more notes were found that appeared to be erotica featuring Lozano and his doctor. It was also reported that they did in fact have sexual relations. After about five years, he committed suicide.

When Bean-Bayog's graphic love notes were discovered, two other therapists informed state authorities. But no investigation was launched until Lozano's suicide made newspaper headlines. Even then, other psychoanalysts circled the wagons, claiming their colleague was the victim of the affair.

Illinois regulators have disciplined Springfield psychiatrist Dr. Duttala Obula Reddy for alleged sexual misconduct with a female patient.

Springfield (Illinois) psychiatrist suspended for ‘sexually inappropriate’ conduct

A Springfield psychiatrist who took over the care of a female patient victimized by “sexually inappropriate” conduct at the hands of another psychiatrist in the same clinic was disciplined by the state this week for sexual misconduct with the patient.

Officials from the Illinois Department of Financial and Professional Regulation issued a temporary suspension of the license of Dr. Duttala Obula Reddy, a psychiatrist at Psychiatric Associates of Central Illinois, 1124 S. Sixth St.

For the time being, the state's action prevents Reddy from continuing to practice medicine legally. Reddy, a 64-year-old Chatham resident, couldn't be reached for comment, and an office manager at Psychiatric Associates didn't return a phone call from The State Journal-Register.

According to documents from the state, Reddy began providing psychiatric care and treatment to the woman at Psychiatric Associates in 2013 after her previous psychiatrist, Dr. Kripakaran Puvalai, resigned from the clinic in September 2013.

Puvalai, 58, was suspended from the practice of medicine by the state in October 2013 for engaging “in a pattern of sexually inappropriate conduct with multiple female patients of Psychiatric Associates.” Those patients included the patient whose care was taken over by Reddy, state officials said.

Puvalai, whose license remains suspended, was disciplined for flirting with and inappropriately touching several female patients between 2009 and 2013 while he practiced at Psychiatric Associates and worked as a consulting psychiatrist at the U.S. Department of Veterans Affairs' outpatient clinic in Springfield.

Puvalai also was punished in the early 2000s by Southern Illinois University School of Medicine, during his psychiatry training in Springfield, for a lack of professional conduct and failure to maintain appropriate boundaries with patients.

[...]

This isn't the first time Reddy has been punished for conduct that allegedly crossed professional boundaries.

[...]

Read more: http://www.sj-r.com/article/20150101/NEWS/150109978/

This is one of those things that just invokes rage

Maine's Riverview Psychiatric Center has failed to abide by the terms of a decades-old consent decree by not adequately reducing the risk of injury to clients and staff and by arbitrarily limiting treatment options for patients

As reported in the Portland Press Herald

Further details at the link.

Riverview Psychiatric Center has failed to abide by the terms of a decades-old consent decree by not adequately reducing the risk of injury to clients and staff and by arbitrarily limiting treatment options for patients, according to a report issued by a former court-appointed receiver and consultant.

Elizabeth Jones was asked to report on observations she made during a three-day visit to Riverview, where the state treats its most severe mental illness cases, including patients sent there through the criminal court system.

Jones listed failures in treatment strategies, failure to provide proper interventions following aggressive acts by two patients and continued risk to patients and staff, a “serious misunderstanding of recovery model” that the hospital ascribes to, and lack of treatment and of outdoor time for Lower Saco unit patients, those who have been found not responsible for criminal conduct because of mental illness.

“Treatment options have been arbitrarily limited and, therefore, the provisions of the consent decree have been violated,” she wrote.

She said the use of seclusion and restraint need to follow consent decree requirements.

“At this time, it appeared that the requisite pro-active alternatives to seclusion and restraint have not been explored or provided consistently to the extent needed,” she wrote. “The lack of individualized treatment interventions and the lack of sufficient training and personnel support place both staff and class members at the risk of harm.”

Jones had a number of observations, including concerns that the state is no longer in compliance with the consent decree that requires individualized treatment plans and adequate staffing. The consent decree settled a lawsuit brought two decades ago by mental health advocates that holds the state mental health system to agreed-upon standards of care.

Daniel Wathen, the court master who oversees the consent decree, requested the visit following a series of problems at the hospital in Augusta, including serious attacks by patients on mental health workers and nurses, the use of a stun gun and pepper spray on patients, and a loss of federal funding estimated at $20 million annually because the Centers for Medicare and Medicaid Services had withdrawn the hospital’s certification.

Jones’ report was made public on Wednesday, though Wathen said he and Jones met immediately after the hospital visit with the commissioner of the state Department of Health & Human Services, and the hospital received a copy of the report on Monday.

Dr. Khristine Eroshevich, Beverly Hills Psychiatrist Who Treated Anna Nicole Smith, Has License Suspended

As Reported in the Huffington Post

LOS ANGELES -- State medical board officials say a Beverly Hills psychiatrist who treated Anna Nicole Smith has had her license suspended for a criminal conviction involving the Playboy Playmate.

The March 30 decision by the Medical Board of California did not name any patients in the case against Dr. Khristine Eroshevich, but the filing listed the court number of the Smith case.

Eroshevich's license was revoked, but the revocation was stayed.

Instead, Eroshevich's license will be suspended for 90 days and she will be placed on five years of probation by the state licensing agency for wrongly prescribing opiates and other misconduct.

As terms of her probation, the board ordered Eroshevich to take classes on prescribing practices, ethics. She must also undergo psychiatric and medical evaluations. When she returns to practicing medicine, it will be under the supervision of a monitor approved by the state's licensing agency.

Eroshevich was with Smith when the former Playboy Playmate checked into the Florida hotel, where she later died of an accidental overdose.

According to the medical examiner's office in Florida, Eroshevich authorized all 11 prescription medications in the Florida hotel room where Smith was found unresponsive shortly before her death on Feb. 8, 2007.

More than 600 pills – including about 450 muscle relaxants – were missing from prescriptions that were no more than five weeks old.

Eroshevich was initially convicted of two felonies in the drug trial involving the treatment of Smith. One was later thrown out and the other was reduced to a misdemeanor. The misdemeanor is under appeal.

According to the medical board filing, Eroshevich admitted misconduct in signing off on two workers' compensation and disability claims without actually examining the patients.

The examinations were done by Eroshevich's colleague in 2004 and 2006.

Thousand Oaks psychiatrist arrested twice for DUI; patient death probed

As seen in this report from Los Angels' ABC7 News

A Thousand Oaks doctor arrested twice for DUI is now under investigation in connection with the death of a patient.

Dr. Daryl Westerback, 55, was arrested on June 5 for driving under the influence of prescription drugs after he was spotted on the road by a narcotics detective.

Westerback is now being investigated for overprescribing drugs to his patients. Authorities are looking into at least one death related to his practice.

"We began looking into him and found that one of his patients last year died of a fatal overdose, so we're now opening the case and investigating that death," said Capt. Don Aguilar with the Ventura County Sheriff's Department.

Westerback, a psychiatrist, is also accused of treating patients while he was impaired by prescription drugs.

"We started watching him and found that he was also under the influence of opiates while seeing patients. We found that he was operating a psychiatry office and was treating pain-management patients without an exam room, without all the typical methods of good medicine," said Aguilar.

Officials say they are investigating at least 10 doctors for operating criminally in Ventura County. They say these doctors appear to be nothing more than drug dealers peddling prescription medications for profit.

Ventura County sheriff officials say federal law enforcement is helping with a special task force to crack down on the growing illegal use of prescription drugs like Oxycontin, Vicodin and more.

"This has been created out of a prescription drug problem we've been seeing in the county, specifically in East County," said Aguilar.

Detectives said Westerback's license to prescribe medication has been suspended and he remains free on bail.

Westerback was also arrested for driving under the influence of drugs and felony child endangerment after being involved in a car crash in Thousand Oaks on March 8, according to Ventura County Assistant Sheriff Gary Pentis.

Two Top Liability Risks for Psychiatrists: Patients with Suicidal Behavior and Psychopharmacology

as seen in this PRMS (Professional Risk Management Services) press release

Snippet:

Patient suicides may trigger the most lawsuits, but according to PRMS data, cases with the largest verdicts or settlements don't involve the death of a patient, but significant and permanent physical and neurological damage requiring lifelong care. Such damage can occur from things like renal failure from lithium toxicity, severe Stevens-Johnson Syndrome or brain damage from a suicide attempt.

"Defensive medicine is not the answer," said Jacqueline Melonas, RN, MS, JD, Senior Vice President of Risk Management for PRMS. "Care that has a sound clinical basis that also is well-documented is the best way to avoid or, if necessary, defend lawsuits."

more at the link

Trial for psychiatrist Dr. William Ayres, accused of molestation begins

Report from the San Mateo County Times

After two years of events worthy of a prime time legal drama, embattled child psychiatrist Dr. William Ayres will finally stand trial Monday. He is accused of molesting seven of his young male patients.

Ayres, 77, was a prominent member of the San Mateo medical community and served as president of the American Academy of Child and Adolescent Psychiatry.

He also performed physical examinations and inspected the genitalia of many of his juvenile psychiatric patients.

The once well-respected doctor was arrested in April 2007 and charged with 14 counts of lewd and lascivious acts with three victims, ages 9, 11 and 12 at the time of the alleged abuse.

The case's publicity brought forward four more accusers, bringing the number of Ayres' felony molestation counts to 20. He was freed on $750,000 bail.

The shocking story made international headlines, and the trial beginning Monday is expected to draw more public attention.

"We are exceedingly pleased that we are now on the doorstep of getting justice," San Mateo County Chief Deputy District Attorney Steve Wagstaffe said Friday.

A trial judge will be selected by Judge James Ellis in San Mateo County Superior Court in Redwood City on Monday morning.

Wagstaffe predicted jury selection and pretrial motions would take two weeks, but that the entire trial would last eight to 10 weeks.

Ayres practiced for decades in San Mateo County, seeing patients referred to him
through local school districts and the county's juvenile court, in addition to his private practice.

[...]

Police first began investigating him in 2002 after being told by a man who was a patient of Ayres in the 1970s that the doctor had molested him on multiple occasions. But the case had to be dropped after a U.S. Supreme Court ruling effectively changed the statute of limitations on such cases.

Childhood molestation can only be brought by victims who are younger than 29 or whose alleged abuse occurred after Jan. 1, 1998.

The San Mateo Police Department reopened the case in March 2006, at the urging of a friend of one of the victims to seek out other possible victims who fell within the legal statute of limitation.

That friend was New York-based freelance writer Victoria Balfour, who made it a personal crusade to unearth possible molestation victims of Ayres and help authorities build a case against him.

A search warrant was executed for Ayres' records, and a list was compiled of more than 800 patients.

Prosecutors believe they know of at least 39 former patients of Ayres who had been molested by him, but most did not fall under the state's statute of limitations.

After seven months of exhaustive and painful interviews with patients on the list, police took Ayres into custody at his San Mateo home on April 5, 2007.

Ayres' medical license was suspended, and has since expired.

On April 28, 2007, the child psychiatrist accused of molesting dozens of pre-adolescent boys in San Mateo County for decades declared his innocence of the multiple counts against him.

Now, more than two years later, the once-prominent child psychiatrist's fate will likely be left to a jury.

[...]

Ayres was known nationally as one of the country's top child psychiatrists; he was just as well respected on the Peninsula where he ran a private practice for decades.

He was probably one of fewer than 10 San Mateo County psychiatrists with a subspecialty in child and adolescent psychiatry, according to San Mateo County Medical Association Executive Director Sue Malone.

He told colleagues he performed medical examinations because that was the way he had been trained. He had done his residency in the early 1960s at the Judge Baker Center in Boston, one of the country's premier centers for the study of child psychology.

While most child psychiatrists admit that administering physical exams to patients is uncommon today, many professionals defend the practice as another instrument in a psychiatrist's toolbox.

A spokeswoman from the American Academy of Child and Adolescent Psychiatry, of which Ayres was president for more than a decade, told MediaNews that performing physicals on patients in a psychiatric setting can be "consistent with good medical practice."

Wagstaffe said he expected attorneys on both sides to present expert opinions on the matter.

While the passing of time between charges and trial can often damage prosecutors' cases, Wagstaffe said all their witnesses were ready to go.

"This case is more than ripe for trial," he said.

Anna Nicole's doctors Sandeep Kapoor and Khristine Eroshevich charged in her death

As reported in the Independent, psychiatrist Khristine Eroshevich has been charged with others for misconduct in the death of Anna Nicole Smith. Documents obtained after Smith's death showed Eroshevich authorized all 11 prescription medications found in the model's hotel room the day she died. Most of the drugs were prescribed in the name of Stern, her lawyer-turned-companion, and none were prescribed in Smith's own name.

Anna Nicole Smith's boyfriend Howard K. Stern and two doctors have been charged with giving thousands of prescription drugs to the former Playboy Playmate in the years leading up to her fatal drug overdose in 2007.

Stern and doctors Sandeep Kapoor and Khristine Eroshevich were each charged yesterday with three felony counts of conspiracy and several other charges of fraudulent prescriptions. Prosecutors said the doctors gave the drugs — including opiates and sedatives — to Stern, who then gave them to Smith.

The prescriptions were issued between June 2004 and January 2007, just weeks before Smith's death.

"These individuals repeatedly and excessively furnished thousands of prescription pills to Anna Nicole Smith, often for no legitimate medical purpose," California Attorney General Jerry Brown said in a statement.

Brown's spokesman, Scott Gerber, told The Associated Press that Stern and Kapoor surrendered last night and posted $20,000 bond, and that Eroshevich will surrender Monday. An arraignment date was not set.

The medical examiner's office has said Eroshevich, a Los Angeles psychiatrist and friend of the starlet's, authorized all the prescription medications found in the Hollywood, Florida, hotel room where the 39-year-old Smith was found unresponsive shortly before her death in Feb. 8, 2007.

Eroshevich's attorney, Adam Braun, acknowledged his client wrote some of the prescriptions using fictitious names for Smith, but said that the intent wasn't to commit fraud.

"It was done for privacy reasons," Braun told the AP. "She did the best she could under difficult circumstances in the best interest of the patient."

Braun said Eroshevich began treating Smith following the death of the playmate's son in September 2006. The doctor traveled on several occasions over a six-month period to the Bahamas where Smith was living with Stern and wrote the prescriptions.

The criminal complaint also alleges Kapoor wrote prescriptions for Smith under a patient alias Michelle Chase. Prosecutors allege the doctor gave her excessive amounts of sleep aids, opiates, muscle relaxants and methadone-like drugs used to treat addiction, knowing she was an addict.

Messages left with attorneys for Stern and Kapoor were not immediately returned.

Brown said Eroshevich and Kapoor "violated their ethical obligations as physicians, while Mr. Stern funneled highly addictive drugs to Ms. Smith."

The criminal complaint includes eight other felony charges, including obtaining fraudulent prescriptions and unlawfully prescribing a controlled substance. In all, Stern faces six felonies and the doctors each are charged with seven. Prosecutors did not immediately know how many years in prison they faced if convicted.

Rumors swirled for weeks after Smith's death, but police cleared those around Smith of any wrongdoing and the medical examiner's probe deemed it an accidental overdose.

Because the playmate was found unresponsive in a hotel on American Indian land, the case was handled by tribal police and their exemption from public records laws kept most of the investigation from being made public.

Documents obtained by The Associated Press after Smith's death showed Eroshevich authorized all 11 prescription medications found in the model's hotel room the day she died. Most of the drugs were prescribed in the name of Stern, her lawyer-turned-companion, and none were prescribed in Smith's own name.

The quantity was staggering. More than 600 pills — including about 450 muscle relaxants — were missing from prescriptions that were no more than five weeks old. Ultimately, it was a syrup — the powerful sleeping aid chloral hydrate — blamed with tipping the balance in the toxic mix of drugs and causing her death.

Stern, who initially claimed he was the father of Smith's infant daughter, Dannielynn, appeared distraught as he spoke last year at a memorial marking the one-year anniversary of Smith's death.

"Few people who knew Anna might not realize how smart she actually was because unless she wanted you to know you didn't know," Stern said.

Stern, who came to the Bahamas with Smith during her pregnancy in 2006, gave up custody of Dannielynn in spring 2007 after DNA tests proved Smith's ex-boyfriend Larry Birkhead was the father.

Dannielynn has been named the sole heir of her late mother's estate, with Birkhead and Stern as co-trustees. Dannielynn could inherit millions of dollars if the estate wins an ongoing court fight over the oil fortune of Anna Nicole's late second husband, J. Howard Marshall.

Sacramento judge castigates psychiatrist who vouched for killer

A Report from the Sacramento Bee

Napa State Hospital's attempt to release a killer into community treatment in Sacramento was based on the "horrifying" testimony of a psychiatrist who "clearly committed perjury in this court," a judge said Monday.

Sacramento Superior Court Judge Kevin J. McCormick made his comments about the Napa psychiatrist, Dr. Nathan Thuma, when he ruled from the bench that Ronald Benjamin Toppila is not fit for outpatient treatment and must remain in the mental hospital for killing his mother four years ago.

In a decision that will keep Toppila confined indefinitely on a jury's verdict that he was not guilty by reason of insanity, McCormick lashed Thuma for recommending in March that the defendant be released into community treatment even though at that time the psychiatrist had examined the client for barely a half hour.

McCormick said Thuma "could not have had enough information" to make the recommendation and that it was "beyond belief" the doctor could have reviewed Toppila's medical records in the short time he'd been on staff at Napa.

Thuma demonstrated "a total lack of independence and judgment" by concluding that Toppila did not present a danger because, in quoting the psychiatrist, "we all trust Mr. Toppila," McCormick said. The judge said Thuma's "demeanor and manner" in court "could only be described as horrifying."

"He clearly committed perjury in this court," McCormick said of Thuma. "He testified inconsistently at varying times. He showed a complete lack of any insight whatsoever into Mr. Toppila's history."

Thuma did not return a telephone call for comment Monday. A spokeswoman for the state Department of Mental Health said agency director Stephen Mayberg plans to review the judge's comments about Thuma.

"He would take it very seriously and look into it," the spokesman, Nancy Kincaid, said.

"If the judge expressed concern over someone's testimony or professional performance, that would be looked into both by the director of the department and by the executive director at the hospital."

McCormick did not specifically identify areas of Thuma's testimony where he thinks the psychiatrist lied under oath. In Thuma's testimony on Oct. 27, however, he wound up on both sides of a question on whether he thought Toppila had "malingered" to sway the therapists who were evaluating him. There were also inconsistencies in Thuma's testimony over whether he was aware of evaluations done on Toppila before the Oct. 7, 2004, beating death of his 86-year-old mother, Hilma Tone.

Deputy District Attorney Dawn Bladet hailed the judge's ruling, saying in an e-mail: "Toppila's continued confinement in Napa State Hospital is necessary to protect the public safety interest."

Toppila's lawyer, Robert J. Saria, said Toppila and his client's family were disappointed by the ruling. Saria said Toppila "is committed to returning to Napa and pursuing his treatment plan and engaging in all the treatment he is required to."

Toppila, 68, a long-time licensed clinical social worker, stabbed his mother 52 times and also bludgeoned her in the fatal attack in her South Land Park apartment.

Judge McCormick said he was also disturbed by the testimony of Antonio Alocer, an official from the Central Valley Conditional Release Program, which would have coordinated Toppila's community placement if he was released from Napa. McCormick said no treatment plan had been determined for Toppila in the event of his release. The judge said Alocer "could not tell me" where Toppila would be placed.

Alocer could not be reached for comment Monday.

"I cannot state with any degree of certainty based on the evidence that I heard in this courtroom that Mr. Toppila no longer poses a danger to the health and safety of others," McCormick said.

Woman describes alleged abuse by psychiatrist

From a Report in the West Australian

A 62-year-old woman has described freezing with fear as her psychiatrist sexually abused her during a session for post-natal depression in the 1970s.

Former psychiatrist Alan John Stubley, 80, is on trial in Perth Supreme Court accused of forcing sex offences against two of his female patients in the mid-late 1970s.

One of the alleged victims today told the jury the doctor had abused her on her first face-to-face session after being discharged from a psychiatric hospital where Dr Stubley had treated her for post-natal depression.

She said she had been shocked when the doctor told her to sit on his knee.

“It was just a terrible silence and then he repeated it (in a tone that) was very authoritative, quite demanding,” she said.

“He put his hand on my leg and he rubbed his hand up my leg and between my legs.

“I just froze, I was just so afraid. I was afraid of him and what he might do to me.

“I said I didn’t want to do this.”

Prosecutor Alan Troy said Dr Stubley had abused his position by taking advantage of his patient’s vulnerability in the pursuit of his own sexual gratification.

He said the two women submitted to the sexual contact because they had felt intimidated.

Mr Troy said one of the victims, who continued seeing the doctor for decades, had feared that no-one would believe her if she spoke out at the time about the alleged abuse.

“She had recently been in a psychiatric hospital and she didn’t think anyone would believe her,” Mr Troy said.

Mr Troy said she also feared she would be put in an institution if she did not continue to see him.

Defence lawyer Mark Trowell said the sex between his client and the women was consensual and there had been no intimidation.

“This is not a court of morals…he may well have acted unprofessionally as a doctor but that doesn’t make him guilty of criminal charges,” Mr Trowell said.

Psychiatrist faces review in wake of massacre - Hearing to decide competency of Toronto doctor who treated man who killed his wife and children

As seen in the Globe and Mail. Edited for Space

The competency of a Toronto psychiatrist who was treating Chau Huc Minh at the time he massacred his family in 2006 is under scrutiny by the College of Physicians and Surgeons of Ontario.

The College has scheduled a hearing to determine whether the psychiatrist - Dr. Hung-Tat Lo - is competent to continue practising in light of his actions in the Chau case and 15 other unspecified cases.

The main complaint behind the hearing appears to be one lodged last year by Mr. Chau's sister, Jenny Chu. Ms. Chu alleged that Dr. Lo refused her plea to have Mr. Chau sent to a hospital for an assessment and possible treatment on Jan. 6, 2006. Five weeks later - on Feb. 9, 2006 - Mr. Chau used a meat cleaver to inflict fatal injuries on his wife, Shao-Fang, his three-year-old daughter, Vivian, and his five-month-old baby, Ivan.

A CPSO document states that its disciplines committee will decide whether Dr. Lo "failed to maintain the standard of practice and is incompetent in his care and treatment - including, but not limited to - his assessments, diagnoses, treatment and record-keeping, of 15 patients whose identities have been made known to Dr. Lo, between about July, 1983, and July, 2007."

It said the probe will also consider whether Dr. Lo displayed "a lack of knowledge, skill or judgment or disregard for the welfare of his patients of a nature," to the point that his practice should be restricted or terminated.

In the meantime, Dr. Lo has been told to submit sample medical charts and other patient information at least once every two weeks to a doctor appointed by the College to monitor his work.

CPSO spokesman Jill Hefley said in an interview yesterday that a complaint is referred to a disciplines hearing only if there has been a determination that "reasonable and probable cause" exists to believe it may be well founded.

Ms. Chu complained that she told Dr. Lo that her brother's behaviour had grown alarmingly erratic. "I was concerned that he might hurt his two young kids and wife" she said in her complaint. "Therefore, I urged Dr. Lo to send him to hospital with detailed descriptions of his strange behaviour."

[...]

Upon leaving Dr. Lo's clinic that day - Jan. 6, 2006 - Ms. Chu claimed that she tried to coax her brother to go straight to the hospital. She said that Mr. Chau became furious, and said: "Even Dr. Lo said that I was okay. Why must you make me go to a hospital?"

Mr. Chau was found not criminally responsible in the killings earlier this week by a Toronto judge.

According to a transcript from Mr. Chau's 2007 preliminary hearing, Dr. Lo denied that Ms. Chu asked him to admit her brother to hospital at the Jan. 6, 2006, meeting. Dr. Lo acknowledged that he saw Mr. Chau for just 140 minutes during the 12 years that he treated him. However, Dr. Lo, who stated he sees 15-20 patients a day, said that he didn't see it as necessary to spend more time with Mr. Chau.

Dr. Lo's office was closed this week, and he did not return telephone messages.

Peter Lindsay, Mr. Chau's defence lawyer, expressed misgivings yesterday about the quality of care his client was given. "The compelling story here is that Dr. Lo sees him so little. If you do the math, he saw him for just over 11 minutes a year. I'm not a doctor, but I think that's far short of what he should be seeing this guy."

[...]

Other victim

Chau Huc Minh was not the first of psychiatrist Hung-Tat Lo's mentally ill patients to explode into violence.

In 2004, two years before Mr. Chau's killing rampage, a 36-year-old Chinese immigrant, Xuan Peng, drowned her four-year-old, autistic baby in a bathtub at her Scarborough home.

She had been under Dr. Lo's care at the time.

According to a 2005 bail ruling that freed Ms. Peng pending her first-degree murder trial, Dr. Lo was treating her for a bipolar disorder at the time that her daughter, Scarlett, drowned.

The presiding judge at the bail hearing was Ontario Superior Court Judge David McCombs.

He was persuaded to grant Ms. Peng bail partly based on testimony from Dr. Lo, who said that she was capable of being managed in the community and agreed to supervise her treatment.

[...]

Police arrested Ms. Peng seven months after Scarlett's death. Last March, she was found guilty of second-degree murder, notwithstanding her history of mental illness.

William Hamilton Ayres Watchdog Site

We now have a blog devoted to tracking the declining career William Hamilton Ayres

William Hamilton Ayres is a "noted" former child psychiatrist who now stands accused of molesting many young boys over the course of his long career. For those not familiar with the case, click on career milestones below the mugshot.

William Hamilton Ayres

Career Milestones

Great Background Article!

Another Good Background Article

Ayres' California Medical License

2003: Ayres Sued - Confidential Settlement

04/06/2007: Arrested

04/12/2007: Prohibited from practicing.

04/13/2007: In Jail Again.

07/24/2008: Trial in January 09

William Ayres: Unmitigated Gall

Time keeps on slipping, slipping, slipping...