VA to look into overmedication reports at Tomah center

From an AP Report in the San Francisco Chronicle

The U.S. Department of Veterans Affairs is launching an investigation into reports of overmedication and retaliatory management practices at the VA Medical Center in Tomah, the agency said Thursday.

Veterans Health Administration specialists plan to visit the western Wisconsin facility within two weeks to review medication prescription practices, the federal agency said in a statement Thursday afternoon. They also plan to send representatives from the Office of Accountability Review to look into allegations of retaliatory behavior.

"My sense is that this isn't just unique to Tomah," U.S. Rep. Ron Kind, a Democrat whose district includes Tomah. "We have a system-wide issue that needs to be addressed when it comes to pain management with our veterans."

Kind and other Wisconsin lawmakers had sent requests to Veterans Affairs Secretary Robert McDonald this week seeking an investigation

Tomah VA spokesman Scott Farley said in a statement the medical center will fully cooperate with the investigation.

A recent story from The Center for Investigative Reporting noted the number of opiates prescribed at the Tomah VA had more than quintupled between 2004 and 2012, even as the number of veterans seeking treatment there has declined. Health care professionals have complained about the medical center's practices for several years.

Here is more info from The Center for Investigative Reporting Looks like the main culprite is, of course, another damn psychiatrist Dr. David Houlihan

Politicians from both parties and government bureaucrats are rushing to look into allegations of rampant overmedication, retaliatory management practices and preventable overdose deaths at the U.S. Department of Veterans Affairs Medical Center in Tomah, Wisconsin, that The Center for Investigative Reporting revealed last week.

In the story’s wake, the VA has begun “actively reviewing allegations of retaliatory behavior and overmedication at the Tomah VA Medical Center,” said agency spokesman James Hutton. He said the facility’s chief of staff, psychiatrist Dr. David Houlihan, has been temporarily reassigned to the VA regional office while an internal investigation takes place.

But the problems disclosed should not have surprised politicians or federal officials: Health care professionals at the hospital have complained for at least five years about Houlihan’s prescription practices and his retaliatory management style – filing numerous reports with those in charge of oversight.

“It’s about time,” said Robin Weeth, a former social worker at the hospital who wrote to the VA inspector general in 2012 with a long list of allegations, including that “veterans are overmedicated and have been driving while impaired, fallen asleep while smoking and set themselves on fire.”

Today, Weeth reports that he never heard back from the inspector general.

The CIR story reported that the number of opiates prescribed at the Tomah VA had more than quintupled between 2004 and 2012, even as the number of veterans seeking care at the hospital declined. It included details of the August death of a 35-year-old Marine Corps veteran, who overdosed while in the hospital’s inpatient psychiatric ward.

[...]

The VA inspector general had closed an investigation into the Tomah VA before Baldwin even got in touch, in March 2014. The inspector general’s report noted that Houlihan’s narcotic prescriptions were “at considerable variance compared to most opioid prescribers” and “raised potentially serious concerns” that should be brought to the attention of the federal agency’s leadership. But the report suggested no punishment.

Weeth said he believed that Jason Simcakoski, the 35-year-old former Marine who fatally overdosed in the Tomah VA psychiatric ward in August, still would be alive today if the inspector general had come down harder on Houlihan.

[...]

Much more information at the links

Psychiatrist loses appeal over sex crimes

A report from the Washington Poston the final failed appeal of a psychiatrist caught doing the wrong thing. Part of a much larger article.

The hearing was entering its 10th hour Thursday night when Arlington County psychiatrist Martin H. Stein learned that his 40-year career as a practicing physician was effectively over.

The Virginia Board of Medicine denied Stein's petition to reinstate the license he surrendered six years ago for his treatment of 10 patients, among them a 4-year-old whose legs he bound with duct tape.

The three-member panel found that Stein had harmed 17 other patients by over-prescribing sometimes dangerous combinations of drugs, diagnosing nonexistent conditions and engaging in unethical behavior with female patients.

Stein, 67, who declared personal bankruptcy five years ago and has been sued more than 15 times since 1995, may reapply or appeal. But both are expensive, time-consuming processes with virtually no chance of success.

Links to earlier Stories

• From the Archives: Va. Doctor's Misconduct Left Trail of Broken Lives
• From the Archives: A Broken Marriage And a 'Life Destroyed'

Psychiatrist Fails to Get License Restored

Via the Washington Post

The Virginia Board of Medicine said last night that it would not restore the medical license of well-known Arlington County psychiatrist Martin H. Stein.

In 2002, Stein was stripped of his medical licenses in Virginia and the District for negligence; inappropriate and excessive prescribing of drugs for patients as young as 4; and sexually intimate behavior with a patient.

During a nine-hour hearing in Richmond, Stein, 67, apologized for "any harm" he caused but told the three-member panel he wanted a second chance to offer "some very special skills." The Maryland psychiatrist treating Stein for bipolar disorder testified that Stein was fit to return to limited practice.

The panel sided with the recommendation of its staff and a director of a program for troubled doctors at Virginia Commonwealth University. Physician Patricia Pade told the board that Stein's problems were the result of "characterological" issues, not just mental illness.

Cho, Va. Tech and System Failure

Various comments on the Washington Post about the report regarding the investigating the shooting at Virginia Tech.

Vunderlutz wrote that, "The brunt of the criticism should be directed at the lack of follow-through by the courts and the mental health professionals. But, all in all, this was a system failure and the blame, guilt and remorse are shared among many."

And jamalnasir_2000 said, "...this article makes it seem like VA Tech should have had a anti crime force of its own... This school just ended up being a victim of a screwed up/insane person. That can happen anywhere....example Columbine."

UncleWillie concurred, saying that "...the actions of a 1-in-a-million nut like this one remains unpredictable. As a result thousands will be subjected to more stringent rules and procedures which erode our freedoms and will fail to circumvent anything."

terryeo said "It is psychiatry that should be criticized...Treating someone so they kill people is simply not good medical practice... This idea of a psychiatrist using our tax dollars, treating Cho, prescribing Cho psychotropic drugs, and then not being held accountable for Cho's behaviour is beyond good sense."

RustNeverSleeps said, "Va Tech did nothing wrong! College students believe they are invincible and would not have listened to any warnings to stay inside behind locked doors? This commission was another waste of taxpayer dollars."

Last word goes to DardenCavalcade1, who wrote, "In ALL of these tragedies, institutional failures abound and are a principle contributing cause... Commonwealth institutions failed serially and repeatedly to do their damn jobs. Virginia government constantly fails to exercise due diligence in governance: drivers licensing of the 9/11 terrorists, gun laws that provide a statistically significant number of firearms to professional criminals in the Atlantic states, failure to build and repair critical infrastructures, failure to educate, and now the slaughter at Virginia Tech."

The discontent out there is obvious

Mental Health is in Dark Ages

Some people recognize that there is a problem, even if they do not realized that psychiatry is broken, and actually never worked right in the first place. An Editorial from the Virgina Pilot

Here's one image of mental health care in Virginia institutions, circa late 20th century.

Gloria Huntley, a 31-year-old borderline schizophrenic, in and out of hospitals from the time she was 13, died strapped by the arms and legs to a hospital bed at Central State Hospital on June 29, 1996.

Even though her psychiatrist had warned of the danger, Gloria lay spread-eagled in restraints for 300 hours in the last month of her life, including two stretches of 4-1/2 days each.

Here's an image of mental health care in Virginia's more community-driven system, circa early 21st century.

"My son's bipolar, he's off his meds, he has a history of psychotic behavior. You've got to do something! He's sick! Help him please!" Pete Earley, author of the recently published book "Crazy," records a nightmarish attempt to get his mentally ill son admitted to a Northern Virginia hospital.

"Your son is an adult," the physician replies, "and while he is clearly acting odd, he has a right under the law to refuse treatment."

It is only a matter of time until that son breaks into someone's home and faces two felony arrest warrants.

What unites an era of institutions for the mentally ill and an era of deinstitutionalization, in which jails and prisons often wind up as default holding pens? The awareness that mental illness can be hell, no matter when or where.

Think we've progressed far from the era when Dorothea Dix stormed 19th-century America, exposing the abominable treatment of the mentally ill in jails and prisons? Read Earley's account of the psychiatric unit at the Miami-Dade County jail and you'll doubt it.

Naked prisoners huddled in freezing cells eating food off the floor, then and now.

The April 16 killing of 32 students and faculty at Virginia Tech by a deranged student-gunman is bringing renewed attention to the status and treatment of mentally ill Virginians.

At the first meeting of the blue-ribbon panel appointed by Gov. Tim Kaine to address the Tech shootings, mental illness bubbled to the fore. Kaine confirmed that sense in an impromptu press conference last week.

"Fairly quickly, I felt the mental health issues might come to predominate," he said.

What that panel can most likely provide is a case study in the treatment, or lack thereof, of one young man, Seung-Hui Cho, whose brooding silence apparently intensified during his college years. A more intensive probe of issues will come with a 2008 report from the Commission on Mental Health Law Reform, led by Chief Justice Leroy R. Hassell Sr.

When it was launched last year, that study spawned an unnecessary challenge from lawmakers - most prominently Virginia Beach Sen. Ken Stolle - who thought Hassell was invading their turf. Now, everyone should just be glad the work is under way and that the final report will carry the cachet of some of Virginia's premier minds.

Yes, as Stolle argued, the legislature has conducted study after study of mental illness in Virginia, and the missing ingredient invariably winds up being money.

But timing is everything in politics. No matter how many lofty studies are collecting dust on library shelves, the intersection of the Virginia Tech shootings and the Hassell study means this one will have an audience far beyond the rest.

Moreover, it is starting from the right point - the grim reality that across the commonwealth, as nationally, prisons and local jails are substituting for the mental health hospital beds that no longer exist.

By one reading, America has simply come full circle. In the Colonial era, families cared for their mentally ill as best they could, and jails picked up the slack. Spurred by horror stories, state asylums were born. Generations later, amid new horror stories, asylums began to shut down.

Now we are back to often inadequate family and community-based care, with jails picking up the slack - and more horror stories.

That's a gross oversimplification, of course.

[...]

Anyone reviewing the long history of mental illness in America knows reform never spells panacea. But current conditions are not the best we can do. Freedom that ends in a jail cell is not preferable to custody in a hospital ward.

We can do better, and we must.

The Actual Trigger at Virginia Tech

We know that the side effects of many psychiatric drugs include obsessive thoughts involving suicide, death, and killing others. Yet often there is some actual thing that triggers the actual event. In this case, a columnist for the New York post may have stumbled on the answer

The following are facts. Make of them what you choose.

On Sunday night, April 15th, 12 hours before Cho Seung-Hui began his killing spree on the Virginia Tech campus, "Dateline NBC" devoted its entire show to telling the story of psychotic murderer Robert Hyde.

Hyde was a bright young man from Albuquerque who began to suffer a steady mental deterioration until, one day, in 2005, at different locations, he shot and killed five people.

Beyond the murders, the NBC show stressed that Hyde was a time bomb who was released from police custody and hospital care despite frightening episodes and warnings from many, including his family, that eventually there would be hell to pay, that eventually he would kill.

Hyde's story, it turned out, was roughly the same as Cho's life story, except for the killing part. Cho hadn't killed anyone, not yet.

The morning after NBC's show aired, Cho, described by schoolmates as an all-night TV watcher, shot and killed two people.

He then returned to his dormitory to mail a parcel to NBC. It included a note from Cho that began, "You forced me into a corner."

Then he traveled to a different section of the Virginia Tech campus, where he shot and murdered 30 more people.

Surely, Cho's diseased mind was prepped and primed to commit mass murder, at some point. But did NBC's show, the night before, serve as his prompt? In his afflicted state, did that "Dateline" installment push him over the edge? It's unlikely that we'll ever know.

Yet, the numerous similarities between the Hyde and Cho stories are inescapable. So is the timing. Cho's rampage began fewer than 12 hours after NBC's episode about Hyde ended. And Cho interrupted his rampage only to send NBC a you-pushed-me-to-do-this missive.

But even if it's all just a matter of bizarre, chilling coincidences, those coincidences seem too great to ignore or dismiss. They're worthy of your attention.

It looks like Cho Seung-Hui had been meticulously planning his crime for months, but had not yet done anything. The TV story led him to a paranoid fantasy that the show was covertly exposing his plans, and that they were talking about him. Instead of surrendering his weapons, he surrendered to the voices in his head. The voices that were there thanks to the side effects of the drugs he had been on.

Did anti-depressants trigger shooting?

As seen in the Chicago Tribune's Health Blog:

Investigators believe that Cho Seung Hui, the Virginia Tech murderer, had been taking anti-depressant medication at some point before the shootings, according to The Chicago Tribune.

Perhaps it's just a terrible coincidence, but Columbine shooters Eric Harris and Dylan Klebold, and Kip Kinkel, the 15-year-old Oregon youth who killed his parents before opening fire on his classmates, were also taking drugs for depression.

It's not yet clear what, if anything, Cho was on.

But anti-depressants are a leading suspect because they've been shown to pose a suicide risk for children; the drugs come with a federal “black box” warning. And a recent federal analysis of clinical trials showed for the first time that it can also trigger suicidal behavior among patients older than 18.

But are the drugs, which can trigger mania, psychosis, paranoid reactions and abnormal thinking, to blame? Or are they simply unable to stop people like Cho from a rampage?

Dr. Ann Blake Tracy, executive director of the International Coalition for Drug Awareness, was a consultant to 19-year-old Columbine victim Mark Taylor, who filed a lawsuit against Solvay Pharmaceuticals Inc., which manufactured Luvox (Fluvoxamine), the drug prescribed to shooter Eric Harris.

Tracy, the author of “Prozac: Panacea or Pandora?” (Cassia Publications, $23.95) has said:

“The Columbine killers’ brains were awash in serotonin, the chemical which causes violence and aggression and triggers a sleep-walking disorder in which a person literally acts out their worst nightmare,” wrote Christopher Bollyn in the weekly magazine, American Free Press.

[...]

Cho, Harris and Klebold are all dead. Only Kip Kinkel--now 25--is still alive to help shed light on whether the drugs acted as an accomplice.

The Failure of the Modern Mental Health System at Virginia Tech

First there's this tidbit from a much longer worthy post on the Hot Air Blog regarding the developing information on VT Shooter Cho Seung-Hui

There’s new information about him this morning but most of it is stuff we already know. The cops held a press conference to say that he stalked two women in 2005 and then got sent away to a mental hospital for a spell, which we learned last night from that bizarre CNN interview with his two former roommates. Meanwhile, the NYT has a scoop about the cops having initially misidentified the suspect in the first shooting as Emily Hilscher’s gun-aficionado boyfriend. If only the LA Times hadn’t had the same scoop hours earlier.

Here’s some genuinely new information, though, via ABC News. A forensic psychiatrist who’s been following the story says Cho’s behavior sounds familiar, and it goes way beyond depression

Etc.

All of which merely does not damn the mental health workers at the university, who god knows, were trying to deal with all of the craziness that is the modern college student.

The problem is a system that is simply not capable of spotting and then competently handling the fruitcake who might buy a gun in the next year.

By most accounts this guy frightened his professors and classmates.
It was not a problem of spotting him. It was a problem in knowing what was the correct thing to do, as far as Hui was concerned.

(In case anyone has any doubts, the Secret Service long ago put together a profile of people who had been involved in school shootings. Hui seems to have fit this profile very well. You can see a summary of this report here, and the full report here [both in PDF format])

It is not merely a matter of having the ability to lock someone up involuntarily, or to prescribe the right combination of medications. While public safety might be served for a short while by a lock up, or a chemical straight jacket, the fact of the matter is that they did not know what the most effective course of action is in advance.

As an example, just in the past few days, well known Hollywood actor Richard Gere got into trouble in India for kissing a well known Indian Actress on a stage during a benefit for Aids Awareness. The Problem is that in India, kissing in public is considered an obscene act in some quarters! There may even be criminal charges!

I can imagine a person with such strong personal values going to school at any American university would have many personal issues. If you factor in other personal problems, isolation, and the like, I can see the potential for a time bomb developing. The solution for such a person would not be medication.

The people in India rioted due to an event that was, frankly, a severe break with their own traditional expectations and morals. How do you handle a person who has a similar break with their own expectations, etc. due to culture shock, etc. ??? How do you identify such persons?

Part of the solution would be courses in personal relations, successful communication skills, and dealing with people from other cultural backgrounds, courses designed to develop skills to cope with such shocks and clashes with reality.

Normally these things would be "part of growing up", but obviously there are some that arrive at college or university with these skills lacking. To avoid stigma, something like a "Basics in Human Relations" course and a "Fundamentals of Adult Living" course should be required of all freshman and all people transferring into the school

But this is not part of the mental health system. They are not set up to train and educate people in missing social skills. They are there to hand out medications, and to call the cops when people get too weird. They are not equipped to handle anything else. They are not capable of detecting or handling such things, except when the breakdown is so dramatic as to require the men in the white coats, etc.

And that is the major problem. They do not know what to do. Giving them more funds when they do not know what to do will not fix the situation by itself.

And yes, there are even psychiatrists who recognize that America's mental health system is broken, that it is dysfunctional. Not that we agree with the treatment, but there is some recognition of the problem

What Exactly Was Cho Seung-Hui On?

from the Mother Jones Magazine blog

The Times reported that Cho Seung-Hui was taking a psychoactive medication. What was he on? Was it an antidepressant? No doubt antidepressants save lives, but they also cause side effects. Psychiatrists know they trigger mania, exacerbate delusional thinking, and agitate suicidal tendencies. In short, they can push troubled people over the edge.

For obvious reasons, it's kinda hard to clinically research any link between antidepressants and shootings. But I'm certainly not the first person to notice one. For example, the wife of comedian Phil Hartman was on Zoloft when she killed herself and him. Most notoriously, Eric Harris of Columbine was on Luvox.

For more common violent crimes, antidepressant manufacturers years ago actually teamed up with district attorneys to make sure the Zoloft defense didn't fly. As Rob Waters reported:

In the early 1990s, Eli Lilly, the maker of Prozac, started the practice of aiding district attorneys who were prosecuting defendants who blamed the drug for their acts of violence. Lawyers for Pfizer, the world’s largest pharmaceutical company, later created a “prosecutor’s manual” for the same purpose.

The Zoloft manual itself is a closely held secret -- and Pfizer has fought hard to keep it that way.

In 2001, a widow sued Pfizer because her husband shot and killed himself after six days on Zoloft. Her lawyers discovered in Pfizer’s records a reference to a document called “prosecutor’s manual,” and requested a copy.

Pfizer fought the request, claiming it was privileged information between the company and its attorneys. The judge allowed the manual to be introduced -- noting it was designed to prevent “harm to Pfizer’s reputation” if a defendant successfully raised “a Zoloft causation defense” -- but he agreed to thereafter seal the manual and keep it out of the public record.

James Hooper, an attorney for Pfizer, says that “in rare cases” the company’s attorneys have provided the manual to prosecutors if a defendant “is attempting to blame some sort of criminal behavior on the medicine."

Here is the link to the article Prosecuting for Pharma: Antidepressant manufacturers team up with district attorneys to make sure the Zoloft defense doesn’t fly.

Virginia Tech Gunman Cho Seung-Hui Was on Anti-Depressants

It seems Virginia tech gunman Cho Seung-Hui may have been on anti-depressant drugs after all.

As seen on Fox News, which references these reports from ABC News and the Chicago Tribune.

The gunman responsible for at least the second of the two Virginia Tech attacks that claimed 33 lives to become the deadliest shooting rampage in U.S. history has been identified as Cho Seung-Hui, a campus student in the United States on a permanent resident visa, Virginia Tech police said Tuesday.

But police are still searching for a motive.

"He was a loner, and we're having difficulty finding information about him," school spokesman Larry Hincker said.

Sources told ABC News that after Cho killed the one female and one male at West Ambler Johnston Monday morning, he returned to his own dorm room where he re-armed and left a "disturbing note" before entering Norris Hall on the other side of campus to continue his rampage and kill 30 more before shooting himself.

The Chicago Tribune reported that the note included a rambling list of grievances that railed against "rich kids," "debauchery" and "deceitful charlatans" on campus. The paper also reported that Cho died with the words "Ismail Ax" in red ink on the inside of one of his arms.

Quoting an "investigative source," the newspaper said Cho had shown recent signs of violent, aberrant behavior, including setting a fire in a dorm room and allegedly stalking some women, and that he was taking medication for depression.

See also this report from the Charleston Daily Mail

The gunman suspected of carrying out the Virginia Tech massacre that left 33 people dead was identified today as an English major whose creative writing was so disturbing that he was referred to the school's counseling service.

News reports also said that he may have been taking medication for depression, that he was becoming increasingly violent and erratic, and that he left a note in his dorm in which he railed against "rich kids,'' "debauchery'' and "deceitful charlatans'' on campus.

I have found various relevant notes and links to videos posted here

Of course, Dr. Phil blames Video Games.

As one commenter noted:

Of course, rather than trying to address the problems of why they’re a sociopath or trying to help others with similar mental illnesses, it’s easier to just pin the blame on the entertainment.

How can someone say that, and not realise the major logical short-circuit there? The problem wasn’t that he was a gamer, it’s that he was a f****** psychopath. Taking his games away wouldn’t have made him any less of a psychopath.

Another Psych Hospital is shutting down

The Culpeper Regional Hospital in Virginia has announced that it will close Pinebrooke Psychiatric Center on October 31. As the hospital noted in a news release:

"The board [of trustees] has agreed that while acute psychiatric care is important, it is not financially viable in the current healthcare economic climate ..."

The review also found that psychiatrists have become harder to recruit.

Virginia Psychiatric Medicine, which is owned by Culpeper Regional Hospital and provides psychiatrists and other mental-health staff members for Pinebrooke, will also close Oct. 31.

[which I note that the facilities will be closing on Halloween.]

Ironic