How the American opiate epidemic was started by one pharmaceutical company

An extended article investigating a corrupt pharmaceutical company Here are some snippets. Well

The state of Kentucky may finally get its deliverance. After more than seven years of battling the evasive legal tactics of Purdue Pharma, 2015 may be the year that Kentucky and its attorney general, Jack Conway, are able to move forward with a civil lawsuit alleging that the drugmaker misled doctors and patients about their blockbuster pain pill OxyContin, leading to a vicious addiction epidemic across large swaths of the state.

A pernicious distinction of the first decade of the 21st century was the rise in painkiller abuse, which ultimately led to a catastrophic increase in addicts, fatal overdoses, and blighted communities. But the story of the painkiller epidemic can really be reduced to the story of one powerful, highly addictive drug and its small but ruthlessly enterprising manufacturer.

On December 12, 1995, the Food and Drug Administration approved the opioid analgesic OxyContin. It hit the market in 1996. In its first year, OxyContin accounted for $45 million in sales for its manufacturer, Stamford, Connecticut-based pharmaceutical company Purdue Pharma. By 2000 that number would balloon to $1.1 billion, an increase of well over 2,000 percent in a span of just four years. Ten years later, the profits would inflate still further, to $3.1 billion. By then the potent opioid accounted for about 30 percent of the painkiller market. What's more, Purdue Pharma's patent for the original OxyContin formula didn't expire until 2013. This meant that a single private, family-owned pharmaceutical company with non-descript headquarters in the Northeast controlled nearly a third of the entire United States market for pain pills.

[...]

Starting in 1996, Purdue Pharma expanded its sales department to coincide with the debut of its new drug. According to an article published in The American Journal of Public Health, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy," Purdue increased its number of sales representatives from 318 in 1996 to 671 in 2000. By 2001, when OxyContin was hitting its stride, these sales reps received annual bonuses averaging over $70,000, with some bonuses nearing a quarter of a million dollars. In that year Purdue Pharma spent $200 million marketing its golden goose. Pouring money into marketing is not uncommon for Big Pharma, but proportionate to the size of the company, Purdue’s OxyContin push was substantial.

[...]

The state of Kentucky's lawsuit against Purdue Pharma is not the first legal trouble the company has run into. In 2007, in United States of America v. The Purdue Frederick Company, Inc., Purdue and its top executives pleaded guilty to charges that it misled doctors and patients about the addictive properties of OxyContin and misbranded the product as "abuse resistant." Prosecutors found a "corporate culture that allowed this product to be misbranded with the intent to defraud and mislead." Purdue Pharma paid $600 million in fines, among the largest settlements in U.S. history for a pharmaceutical company.

[...]

Kentucky is filing a total of 12 claims against the company, including false advertising, Medicaid fraud, unjust enrichment, and punitive damages. In total the suit could cost Purdue Pharma $1 billion (which is just one-third of its annual revenues from OxyContin).

No state has been more devastated by the nationwide opiate problem than Kentucky. Much of the eastern part of the state and the Appalachians has watched as men, women, and teenagers fell victim to the potent pain pills. There were several different gateways — back injuries, operations, parents' medicine cabinets — but all of them led to an implacable addiction that rivals that of the hardest street drugs. And that’s the rub. Because there was simply so much OxyContin available for over a decade, it trickled down from pharmacies and hospitals and became a street drug, coveted by teens and fiends and sold by dealers at a premium (prices often shot up well over $1 a milligram, pricing the popular 80mg tablets at over $100 for a single pill).

Whatever the gray areas on OxyContin's many paths to perdition, the statistics on the first decade of this century bear out a staggering epidemic. From 1999 to 2010, the sale of prescription painkillers to pharmacies and doctors' offices quadrupled. In the exact same time span, the number of overdose deaths from prescription painkillers also quadrupled, rising to almost 17,000.

To call this a coincidence would be analogous to declaring no connection between loosening enforcement on drunk driving laws and observing a sudden increase in deaths caused by drunk driving. It goes almost without saying that these figures dovetail seamlessly with the release of OxyContin and Purdue's marketing timeline, which hit hardest in the early 2000s.

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.

[...]

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.

Former psychiatrist Francis Bostock ordered to pay damages to patient he abused

As reported in The Age

A former Melbourne psychiatrist who had sex with a patient for years and billed Medicare $16,000 for their time together has been ordered to pay the woman nearly $400,000 in damages.

A Supreme Court judge recently heard former Kew psychiatrist Francis Tudor Bostock breached his duty of care by having sex with and sexually assaulting the woman over three-and-a-half years while she had depression.

The patient first sought Dr Bostock's help in 1990 for her mental illness, which other treatments had failed to alleviate.

Dr Bostock initially used psychoanalytical psychotherapy on her with some success, but in 1997, the pair started having sex in his rooms whenever she attended.

While the therapeutic relationship ceased when the sex began, Dr Bostock continued to bill Medicare when she visited his rooms until 1998. In total, Medicare paid him $16,464 for their time together.

The woman visited him up to three times a week until she ended their relationship in 2001. Apart from their sexual relationship, they did not interact or socialise outside of his office.

In her judgment on damages, Associate Justice Melissa Daly said the woman fell in love with Bostock and became obsessed with her therapy and feelings about him.

The woman decided to end their relationship when she learnt about the concept of transference in psychotherapy — the process whereby a therapist, in addressing issues associated with the loss of love from a parent, in effect replaces the role of a parent in a patient's consciousness. This made the woman realise how wrong their relationship was and how Dr Bostock had abused his position of power.

The court heard that during their relationship and for many years afterwards, the woman was consumed by guilt and shame and struggled to work. She became depressed, anxious, untrusting of others and suffered migraines and panic attacks.

In 2005, she started seeing a new psychiatrist, who was angry and appalled by what had happened to her. He told the court that Dr Bostock's sexual relationship with the woman was a major boundary violation that was equivalent to child abuse.

He said the woman was unable to give rational consent to a sexual relationship with Dr Bostock, that his actions "massively damaged" her and had aggravated her mental illness. She now exhibits elements of post traumatic stress disorder and has dreams and flashbacks about him.

In 2010, the woman reported him to the Medical Board. In response, Justice Daly said, Dr Bostock admitted the relationship and agreed to wind up his practice. His registration ceased in early 2011. He was nearly 70 at that time.

While Dr Bostock declared himself bankrupt last year, seven months after the woman issued a writ against him, Justice Daly ordered Dr Bostock to pay the woman $384,029 in damages.

She said Dr Bostock did not file a defence and "as such is taken to have admitted the allegations in the statement of claim".

The woman's lawyer, Slater and Gordon principal Anne Shortall, said her client would pursue compensation when the term of Dr Bostock's bankruptcy ends in 2016.

Widow sues Prairie St. John's Mental Hospital for husband's death by suicide

As reported on the InForum Website

A Fargo widow is suing the mental health hospital here where her husband’s body was discovered after he hanged himself hours after being admitted in April, alleging the hospital was negligent in failing to monitor him.

Jennifer Waagen filed the lawsuit Tuesday in Cass County District Court against Prairie St. John’s Psychiatric Hospital.

Scott Waagen used a bed sheet fastened over the top of the bathroom door to try to hang himself. He was found by a psychiatric technician April 26 and died a week later at Sanford Medical Center.

He left behind his wife and three young daughters, all under 8 years old.

Jennifer Waagen’s lawsuit states her husband was admitted to Prairie St. John’s about 13 hours earlier for continuous surveillance after being diagnosed with a brief psychotic disorder.

The lawsuit accuses Prairie St. John’s of being negligent in failing to document and complete accurate assessments of Scott Waagen, and for failing to watch him and prevent his death by hanging.

Lawyers for Prairie St. John’s filed a response to the lawsuit stating no one at the facility was negligent in caring for Waagen, and that his suicide attempt was not reasonably foreseeable.

Instead, as a suicide victim, Waagen’s death was his own fault, the answer states.

Both sides have explored alternative dispute resolution, according to court documents filed with the case.

Jennifer Waagen is asking for at least $50,000 in economic and non-economic damages.

Another case where the shrinks screwed up, and then blame the patient.

A King County civil jury has ordered Overlake Hospital Medical Center to pay $950,000 in damages to a mentally ill woman who was assaulted while undergoing psychiatric treatment

As Reported in the Seattle Times.

Substantially more details at the link

A King County civil jury has ordered Overlake Hospital Medical Center to pay $950,000 in damages to a mentally ill woman who was assaulted by another patient while undergoing psychiatric treatment at the Bellevue hospital.

Civil attorneys Lincoln Beauregard and Steven Fogg filed the lawsuit last year, alleging that Overlake was negligent because no one was monitoring the video-camera surveillance system in the psychiatric unit where the assault took place. They also alleged that the hospital was not checking in on the mentally ill patients on a regular basis.

“You have a vulnerable 27-year-old woman who was trying to be stabilized. She wasn’t supposed to be sexually assaulted,” Beauregard said Tuesday. “Overlake Hospital repeatedly pointed the finger at her. They said she had opportunities and choices and should have screamed louder.”

The jury reached its verdict Monday after an eight-day civil trial in Superior Court.

Beauregard said his client, who had prior diagnoses of schizophrenia, bi-polar disorder and post-traumatic stress disorder (PTSD), is even more emotionally damaged as a result.

“She now has exacerbated PTSD. She’s severely mentally ill. She’s a fighter who is doing really good trying to get her mental illnesses under control,” Beauregard said.

“This is an unfortunate situation,” Kipepeo “Pep” Brown, the hospital’s director of marketing, communications and community outreach, said in an email Tuesday. “Overlake Medical Center is currently considering our options for appeal. At this point, we cannot comment further on the details of the case or the judgment.”

Lawsuit blames scientist's suicide on psychiatrist

As seen in this report

The widow of a former Los Alamos physicist who took an overdose of sleeping pills blames the death on the Santa Fe psychiatrist who treated him, according to a recent lawsuit.

Stanford P. Lyon was pronounced dead on March 7, 2007, two days after he was found unconscious with an empty bottle of Ambien nearby, according to the complaint filed in state District Court Wednesday on behalf of Patricia C. Lyon.

According to the wrongful-death complaint, psychiatrist Will L. MacHendrie began treating Stanford Lyon for depression and bipolar disorder after he took an overdose of Elavil and Triavil and slashed his wrists in early 1986. Lyon was institutionalized twice in 1998, it says.

In early 2007, Stanford "Lyon began to suffer increased anxiety, insomnia, depression and pessimism," the complaint says. It says he saw MacHendrie four times that February to say he was "terrified," unable to sleep and his concentration was "fragmented."

MacHendrie prescribed Ambien, Zyprexa, Symbyax, Cymbalta, Willbutrin and Exelon, the complaint says, but Stanford Lyon told MacHendrie "he desperately wanted to be placed back on Elavil for treatment of his depression."

On Feb. 28, 2007, Stanford Lyon called MacHendrie to say he was having anxiety, insomnia and "burning hands," the complaint says. Over the next few days, it says, Lyon's panic attack continued, and on March 4, 2007, according to MacHendrie's notes, he spent 20 minutes explaining to Lyon how to use the sleeping medications.

The next day, Patricia Lyon found her husband unconscious and without a pulse. The cause of death was determined to be multiple drug toxicity, resulting from a lethal overdose of Ambien and excessive amounts of Elavil, the complaint says.

The complaint says MacHendrie failed to properly assess Stanford Lyon's condition, to recognize he was a suicide risk, to conduct a suicide assessment, to control his intake of medications, to recognize the dangers of the medications, to have him hospitalized and to warn Patricia Lyon about the medications her husband was taking. This means MacHendrie breached his duties and was negligent, "proximately causing Mr. Lyon's death," it says.

Stanford Lyon, who was in his late 60s, was a physicist who worked in weapons design and materials science for Los Alamos National Laboratory, according to online records.

MacHendrie did not respond to a message seeking comment Friday. Santa Fe lawyers Mark Ish and William Winter, who filed the complaint on behalf of Patricia Lyon, seeking unspecified compensatory damages, funeral and burial expenses, also were unavailable for comment.

The Perils of Industrial Mental Health: Documents were forged, and falsified,

From the Philidelphia Inquirer

The social workers who were supposed to watch over 14-year-old Danieal Kelly didn't do much of anything while she slowly died of starvation and neglect.

But they got very busy after she died, according to a grand-jury report.

The call came Aug. 4, 2006. She'd been found dead, looking like a victim of a concentration camp, with rotting bedsores and weighing 42 pounds.

That afternoon, workers for MultiEthnic Behavioral Health Inc. scrambled to forge documents to make it look as though they had been visiting the girl and her family, as they were being paid to do by the city's Department of Human Services.

In the months before the girl's horrific death, the workers for MultiEthnic were not the only ones who failed to do their jobs - or to try to cover their tracks afterward - according to the grand-jury report.

"The fate of a sweet and promising child depended on the willingness of a number of particular adults to do the bare minimum of what they were supposed to do," the report says.

". . . Had just one of them performed their duty or done their job, Danieal would be alive today."

The DHS caseworker assigned to the family, Dana Poindexter, ignored warnings that the girl was at grave risk, the report alleges, and later lied to the grand jury to make it appear he had been doing his job.

Months after her death, a homicide detective found the case file - at the bottom of a box filled with food wrappers and dusty unopened letters, some of which were four years old.

Poindexter testified he didn't know that Kelly was entitled to go to school, or that it was against the law for a parent not to provide necessary care. "He must have been asleep during his training," one expert told the grand jury.

Pressed to provide a summary of the case a year before her death, Poindexter wrote an account that the grand jury called "pathetic," "self-serving," and "almost certainly false."

Poindexter, who had been suspended three times for poor performance, testified that he prepared many documents and put them in the Kelly case file.

"The grand jury has no doubt that he never prepared these documents," the report said. He is charged with perjury, along with endangering the welfare of children.

Reached by phone, Poindexter, 51, declined to comment. He was suspended again by DHS yesterday.

Another DHS worker, who did not bother to enter the girl's room during her last visit, backdated her report, the grand-jury report said.

And a supervisor admitted she falsified case records to make it seem that DHS had investigated old neglect reports involving the Kelly family and found them "unsubstantiated." Called to testify, she told grand jurors that was common practice at DHS; she said it was a bureaucratic procedure that helped hasten services to families.

That supervisor, Martha Poller, is still with DHS and recently was given a new job: project manager for a team that will examine child-fatality cases. During a news conference yesterday, District Attorney Lynne M. Abraham said she was incredulous that Poller had been entrusted with that new duty.

Poller did not return phone calls yesterday seeking comment.She was not charged.

The 258-page report brims with outrage and fierce criticism of the people involved in Kelly's case - not just of the nine people who were charged, but also the people who ran DHS, the investigators who responded to the death, and even a Public Health Department official who tried to squelch her employees from talking about the case.

The findings in the report echoed, in part, the findings of a DHS review panel that found deep problems at DHS and suggested sweeping reforms.

"What I can tell you is: The internal accountability was weak, and the demand for external accountability from providers was equally weak," said Carol Spigner, the head of the panel.

"When that happens, there are a lot of risks in the system."

The grand-jury report found that the management failures began years ago, before Danieal Kelly even arrived in Philadelphia.

DHS workers complained that MultiEthnic was not visiting families as required and was falsifying records to cover it up.

An investigator for DHS found that the fraud charges were likely true. But the agency wasn't fired. Cheryl Ransom-Garner, who later became DHS director, summoned Mickal Kamuvaka and the other directors of the agency and "read them the riot act," the report said.

Later, a DHS evaluation lauded MultiEthnic for its "energetic" performance, calling it "remarkable." When called before the grand jury, Ransom-Garner said she didn't remember hearing any complaints about the agency - a response the grand jury called "incredible."

Ransom-Garner did not return calls seeking comment. Kamuvaka could not be reached for comment.

These missed chances to check up on MultiEthnic would be repeated again and again, the report found.

The agency's caseworker assigned to the Kelly family, Julius Murray, allegedly visited the home only a few times, and the investigation found no evidence he ever met the child.

In previous cases, Murray and other caseworkers allegedly would have families sign batches of blank forms, attesting to visits that never happened. Murray is charged with doing the same thing in the Kelly case.

The fraud was no aberration - "it was MultiEthnic's modus operandi," the report said.

After the girl's death, the grand jury found, the cover-up kicked into high gear.

A secretary, Vanessa Jackson, was told to come in on her day off on orders from Kamuvaka, "Dr. K." The problem: DHS was coming over for the Kelly family file at 4 p.m., and "Dr. K didn't have much of a file."

She was put to work fabricating notes for home visits that never happened, while another employee sat forging quarterly reports.

"I don't want them to test the notes for the ink to see if they had been written earlier," Jackson quoted Kamuvaka as saying.

They kept a courier from DHS waiting for 20 minutes while they assembled the file.

Like Poindexter, the next DHS worker to get the case, Laura Sommerer, didn't find anything wrong with MultiEthnic's performance. She visited the home June 29 and allegedly saw nothing amiss. She later said she didn't try to speak to the girl.

After the girl died, Sommerer's boss asked her for her report on the June visit; she gave it a day or two later.

But after investigators analyzed her computer, Sommerer admitted she didn't write the report until after the girl died. The grand jury called that "an obvious attempt to cover up her negligence."

During the investigation, the top official in the Health Department also tried to squelch information about the case, the grand jury said.

The doctor who performed the autopsy, Edwin Lieberman, said he was told to keep quiet about the case by Carmen Paris, then the department's acting commissioner.

Edward McCann, who heads the homicide unit for the District Attorney's Office, said that Paris told him it was a miscommunication.

Donald Schwarz, deputy mayor for health, said Paris was suspended pending a hearing today.

In October 2006, after The Inquirer published reports on deaths of other children under DHS supervision, Ransom-Garner at first prepared a counteroffensive - an opinion piece attacking the paper's findings.

She admitted that she didn't bother telling Mayor John F. Street much about the Kelly case "because it wasn't in the press."

But then someone showed Street the photographs of Danieal Kelly. The next morning, on Oct. 20, she was called into the office of Managing Director Pedro Ramos.

"This is the case that is going to take the mayor down," Ransom-Garner quoted him as saying.

There would be no opinion column. Instead, Street fired Ransom-Garner and her top deputy.

Psychiatrist Regrets Becoming A Whistle-Blower

A report from the Sunday Mercury; Birmingham (UK)

A doctor turned NHS whistleblower has revealed her regret at going public with claims of patient abuse at Midland hospitals.

Psychiatrist Rita Pal, from Sutton Coldfield, says her career was 'assassinated' after she made allegations that seriously ill elderly patients were being helped to die by NHS staff.

Dr Pal, 36, presented a dossier of evidence to the General Medical Council but it questioned her sanity - and discussed launching an inquiry into whether she was Wt to practise.

She was later awarded a lucrative settlement against the regulatory body and is still pursuing legal action against it.

Yet Dr Pal has now been banned from practising medicine after the GMC ruled she is no longer registered as a medical practitioner 'for administrative reasons'.

The psychiatrist says she regrets ever speaking out.

"Whistleblowing doesn't work," she told the Sunday Mercury.

"It has cost me an awful lot, my career is assassinated but that's the price I paid.

"It is a long and lonely road, and in the end, I'm left wondering if it was worth it."

Dr Pal said she was first branded a troublemaker soon after beginning her career.

"Fresh out of medical school in 1998, I started work at North Staffordshire Hospital as a house officer continuing my training," Dr Pal recalled.

"It was very intense, with 120-hour weeks, but I had no problems for the first three months.

"Then I was moved to a ward for elderly and emergency patients. I faced an emergency with a patient and there wasn't the basic equipment there.

"I was able to stabilise the patient but phoned the nursing director to say more staff and more equipment was needed as basic care wasn't been met.

"This didn't go down well.

"Other doctors had suffered with poor facilities but no-one ever raised concerns. Patients kept dying and no-one was doing anything."

Dr Pal's outspoken concerns brought her further anxiety.

"I then found myself in a complete nightmare," she said.

"Two weeks later I was accused of disposing of a needle on a day when I wasn't even on the ward. It's a criminal offence under health and safety to dispose of a needle.

"I faced a hearing where I represented myself, and the chargeswere dropped. But I'd already got a name for myself as a 'trouble-maker'.

"The pressure on me to leave was awful and I was advised to move into general practice.

"I moved to Birmingham to do surgery but I had no references and 'whistleblowing' follows you around.

"In 2000, I contacted a newspaper about the elderly patients who were being neglected and worse, being given drugs that hasten death.

"I thought if I raised concerns about healthcare, conditions would at least improve.

"I've had 10 years of fighting for accountability - I feel let down by the NHS.

Man sues hospital, mental health nurse

A report from the Toronto Metro News

t started with an innocent game of chess between a patient and his nurse. But it quickly evolved.

Soon, the pair were having sex all over the hospital — in his room, the staff lounge, examination room.

But their clandestine encounters went beyond the walls of the Centre for Addiction and Mental Health on Queen St. W. When permitted to leave the hospital for a few hours on a community pass, the good-looking 6-foot-3 patient met the woman at a nearby hotel.

Although she was married, their relationship lasted about two years and remained intact even after she was fired from CAMH — an incident he blamed himself for and, in an act of penance, jumped into oncoming traffic.

When she became pregnant last fall, he slipped into a depression, which again landed him in hospital.

It’s an unusual tale that has been pieced together from his clinical notes, a CAMH report and an $850,000 lawsuit recently filed in an Ontario Superior Court.

The patient, identified only as John, is suing CAMH and the nurse, identified as Jane. The court has banned publication of their names to protect the identity of the child.

“I just know that she messed my head up pretty good and that I’ve done things to myself that I never did before,” John told Torstar News Service.

According to the statement of claim, John alleges Jane was negligent in her treatment when she failed to discourage a social relationship, refused to respect professional boundaries and neglected to consider the harm that would result from violating them.

The hospital, it alleges, failed to arrange for appropriate supervision, inspection and monitoring of John at his home. Had they checked on him, John says, they would have discovered her lingerie, strewn about his apartment.

An Open Letter to Dr. Phil

Hopefully this should be the last nail in the coffin of the Dr. Phil and Britney Spears fiasco. But knowing Hollywood, the crazy train hasn't even left the station yet. That said, this open letter by shrink Patricia a Farrell nicely sums ups some of the issues.

The news about Britney Spears and her many problems hasn’t been good and now there’s another problem and it is related to ethics, a person’s right to privacy and their legal right to decide who they want visiting them in a hospital.

Then there’s the HIPPA (Health Insurance Portability and Accountability) matter where hospitals and their personnel aren’t supposed to reveal anything about any patients or even that someone is a patient there.

If they don’t follow HIPPA regs, they leave themselves open to a lawsuit. Of course that only applies to licensed professionals and you're not licensed. Numerous violations seem to have been committed, perhaps, by ignorance. So, let’s set some of the record straight.

Phil, if you look back to the time when you were a licensed psychologist in Texas (which you’re not now because the California licensing board has decided you’re an “entertainer” not a psychologist), you probably remember that confidentiality was the backbone of the field. No psychologist would reveal anything about their patients, but since you’re not a psychologist anymore, I guess talking to the media about someone’s psychiatric problems is permissible. I mean, for an entertainer it is, isn’t it?

You might also remember that after about the age of 16 (depending on the state), everyone has a right to make certain decisions free from the wishes of their parents. That might have been something you ran across when scheduling guests for your entertainment TV show.

So, Britney really should have been the one to invite you to her hospital room, or you should have asked her permission to come to see her. Didn’t you think you were blindsiding her by showing up that way and did any of your prior clinical experience not kick in?

To use a phrase of which you are quite fond: What were you thinking?

Now that the chance to really help Britney has gotten a bit more difficult and has been pushed so publicly away, give your actions some thought and forget about the entertainment value of all this. Britney doesn’t deserve to be dogged the way she is being presently and she doesn’t need to be fed up and served to an audience in all her vulnerability.

Final word: Don’t kick someone when they’re down. It’s really a cheap thing to do and shows no class.

Also of interest is this blog item reflecting on the Britney Spears case:

Actress Frances Farmer came to my mind as I was driving home. She was a famous actress in the '30s and '40s and she was haunted by how cruel the tabloid press could be. She was an easy target. Like Britney, Francis Farmer was drawn to alcohol and drugs and therefore prone to mental illness and self destruction. Farmer had a mother who used her and betrayed her according to her sister's biography. Farmer was in and out of mental institutions her whole life. The tabloid-Hollywood-press loved her tirades and pictures of her often alcohol induced inappropriate behavior garnered top dollar.

What kind of people use the personal carnage of another for entertainment without a thimble full of sympathy? We have devolved into a strange fruit indeed. During one famous episode when Frances Farmer was taken away in hand cuffs, she yelled at the police, "Haven't you ever had a broken heart?" Clearly some part of Britney's heart is broken.

Julia Roberts was recently quoted as saying she knows what it's like to be hounded by paparazzi. Regarding Britney she said, "I just want to hug her." Apparently Britney threw Dr. Phil out of the hospital room 10 minutes after his arrival. So Julia and anyone else with a heart that Britney might listen to, now is the time for the hugs.

ABC News Report on Paxil Addiction

As Broadcast on December 9th, 2004. Here is a clip from that episode

List of Lawsuits Against Atypical Antipsychotic Drugs in the USA

as seen on the PsychSearch Website. All links go to documents stored on the Psych Search website. Excellent research. good work!

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Click links for the references on lawsuits or subpoenas:

Unspecified States

Lilly has received civil investigative demands or subpoenas from the attorneys general of a number of states. Most of these requests are now part of a multistate investigative effort being coordinated by an executive committee of attorneys general. Lilly says they are aware of 26 states participating in this joint effort and they anticipate that additional states will join the investigation. These attorneys general are seeking a broad range of Zyprexa documents, including documents relating to sales, marketing and promotional practices, and remuneration of health care providers. SEC filing

Alaska

State of Alaska v. Lilly Civil action for the damages and penalties arising from the marketing and sale of the prescription drug Zyprexa Article Complaint Description of Claim

Arkansas

Arkansas is planning a lawsuit against Eli Lilly, Janssen Pharmaceutica and Astra Zeneca for “improper and unlawful marketing” of anti-psychotic drugs. The drugs in question are Zyprexa, Risperdal and Seroquel. The Medicaid program of Arkansas has spent $200 million on those drugs over the last eight years and, under Arkansas’ Medicaid fraud law, the state could collect three times that much. Article

Drug companies improperly marketed an anti-psychotic drug, Arkansas Attorney General Dustin McDaniel claimed Tuesday as he asked a state judge to force the firms to repay millions shelled out by the state's Medicaid program for unnecessary prescriptions. McDaniel filed a lawsuit in Pulaski County Circuit Court against Janssen Pharmaceutica Inc., Janssen LP and Johnson & Johnson Inc. (JNJ). In the filing, McDaniel said the companies "engaged in a direct, illegal, nationwide program of promotion of the use of Risperdal for non-medically necessary uses". Article

California

Johnson & Johnson's Janssen unit received a subpoena from the California attorney general's office over sales and marketing of Risperdal. The subpoena asked for documents on "sales and marketing and side effects" of the drug, as well as on "interactions with state officials" in Medicaid.Article

In September 2006, Lilly received a subpoena from the California Attorney General's office seeking production of documents related to their efforts to obtain and maintain Zyprexa's status on California's formulary, marketing and promotional practices with respect to Zyprexa, and remuneration of health care providers. SEC Filing

Eli Lilly & Co., AstraZeneca PLC and Bristol-Myers Squibb Co., revealed that they received subpoenas from California's Attorney General's office to reveal information about their anti-psychotic prescription drugs. The subpoena requests marketing practices and status on California's insurance list of "preferred drugs. (Zyprexa, Seroquel, Abilify) Article

A Pfizer spokesman confirmed that the company received a subpoena Sept. 8, 2006 from the California attorney general's office concerning Geodon. The company is "cooperating fully," said the spokesman, who declined to elaborate. Article

Florida

In June 2005, Lilly received a subpoena from the office of the Attorney General, Medicaid Fraud Control Unit, of the State of Florida, seeking production of documents relating to sales of Zyprexa and their marketing and promotional practices with respect to Zyprexa. SEC Filing

Illinois

The Illinois attorney general's office demanded that Eli Lilly hand over documents concerning the marketing of Zyprexa Article

Louisiana

State of Louisiana v. Janssen A multimillion dollar civil lawsuit against Janssen Pharmaceutical alleges unfair business practices and violations of consumer protection laws. The lawsuit seeks damages for increased medical costs due to side effects suffered and for increased Medicaid expenses due to misleading sales pitches. The suit was filed in connection with the production and marketing of the drug Risperdal. Article

State of Louisiana v. Eli Lilly, Brie Lablanc, Roger Parikh and Gerald Cahee, (Sales Reps for Lilly in Louisiana) Upon information and belief, despite the fact that Zyprexa has not been tested or approved by the Food and Drug Administration (FDA) for pediatric use, Eli Lilly marketed Zyprexa, a potent anti-psychotic drug, for use with children. As a result thereof, many children residing in the State of Louisiana have suffered from Zyprexa related injuries and illnesses such as diabetes, pancreatitis and seizures. Article Complaint

Mississippi

State of Mississippi v. Lilly Mississippi became the fifth state to sue the Indianapolis drug maker over its antipsychotic Zyprexa. Mississippi's attorney general, Jim Hood, charged that Lilly promoted Zyprexa for unapproved uses, including for children. The lawsuit by Hood seeks repayment from Lilly for more than $100 million that the state's Medicaid program for the poor has paid for the drug, plus reimbursement for diabetes-related injuries the drug caused some Medicaid users. Article Complaint

Montana

State of Montana v. Lilly Eli Lilly & Co. was sued by the state of Montana over claims the company fraudulently marketed its antipsychotic drug Zyprexa for unapproved uses and owes the state for prescription costs and harm to patients. Lilly allegedly gave kickbacks to doctors and improperly promoted the drug to nursing homes as a sedative, Montana Attorney General Mike McGrath said in a complaint filed March 7, 2007 in state court in Helena. He claimed Lilly, the world's biggest maker of psychiatric drugs, bought off a ``disgruntled'' sales director to keep him from disclosing its marketing practices. Article Complaint

New Mexico

State of New Mexico v. Lilly Plaintiff seeks to recover the costs of Olanzapine (Zyprexa) induced diabetes and diabetes related illnesses to the State of New Mexico. Complaint

Ohio

Ohio has not sued directly but has attached claims - for $7.5 million so far - to lawsuits involving 1,100 Ohio Medicaid beneficiaries. (Zyprexa) Article

Oregon

Oregon Attorney General Hardy Myers is investigating whether Eli Lilly illegally promoted uses of Zyprexa that have not been approved by the U.S. Food and Drug Administration. Article

Pennsylvania

Commonwealth of Pennsylvania v. Lilly, AstraZeneca, Janssen Eli Lilly & Co., AstraZeneca Pharmaceuticals and Johnson & Johnson were sued by Pennsylvania over claims they fraudulently marketed antipsychotic drugs and owe the state for prescription costs and harm to patients. Lilly, based in Indianapolis, hid the risks and exaggerated the benefits of its antipsychotic medication Zyprexa while persuading doctors to prescribe it for unapproved uses, the state said. London-based AstraZeneca PLC's U.S. unit did the same for its drug Seroquel and Johnson & Johnson's Janssen Pharmaceutical unit for Risperdal, Pennsylvania claimed in a Feb. 26, 2007 complaint. Article Complaint

South Carolina

State of South Carolina v. Janssen Johnson & Johnson, the world's largest maker of health care products, was sued by the state of South Carolina over claims the company's Janssen LP unit fraudulently marketed the antipsychotic drug Risperdal. The companies promoted the drug for unapproved uses, contrary to U.S. Food and Drug Administration regulations, and concealed the risk of diabetes and other side effects, the state said in its complaint. Article Complaint State of South Carolina v. AstraZeneca This is an action by Plaintiff seeking damages for personal injuries and damages suffered as a result of the defective and dangerous pharmaceutical product Seroquel, which was manufactured, marketed, distributed and/or sold by Defendant AstraZeneca Complaint

State of South Carolina v. Eli Lilly The State has discovered that Defendant has engaged in a protracted and willful course of corporate misconduct and misrepresentation... Defendant's failure to provide an adequate warning of the risks of using Zyprexa has compromised the general health and welfare of South Carolina citizens Complaint

Texas

State of Texas and Allen Jones v. Janssen The Texas attorney general says TMAP was just one part of an elaborate marketing scheme to increase psychotropic drug sales. The Texas state attorney general joined a whistleblower lawsuit this past December accusing the pharmaceutical and consumer goods giant Johnson and Johnson inc. of exaggerating the benefits and minimizing the known adverse effects associated with its second-generation antipsychotic Risperdal (risperidone), marketed by subsidiary Janssen L.P. Article Complaint

Utah

State of Utah v. Lilly Prior to selling its product Zyprexa, Lilly knew there was a risk of Zyprexa patients developing severe and harmful health conditions including, but not limited to, hyperglycemia (dangerously high blood sugar levels), acute weight gain, exacerbation of diabetes mellitus and pancreatitis. Furthermore, Lilly was aware of internal studies linking Zyprexa to these conditions, yet failed to warn the United States Food and Drug Administration, the State, physicians, and consumers…as a result of inappropriate marketing of Zyprexa for off-label uses, the State of Utah has paid millions of dollars for inappropriate and medically unnecessary doses of Zyprexa induced diabetes and diabetes related illnesses. The state of Utah is asking for an award for Zyprexa-related damages of past, present, and future medical expenses for recipients of the Utah Medicaid program, the cost of all Zyprexa prescriptions paid by the State, triple damages as a civil penalty and an additional penalty of not more than $10,000 for each prescription that was not medically necessary. Article Complaint

Vermont

Illinois attorney general Lisa Madigan has ratcheted up the pressure on pharmaceutical giant Eli Lilly. Lawyers at the consumer protection division of the Illinois attorney general's office last week demanded that company officials hand over documents concerning the marketing of Zyprexa, Lilly's blockbuster mental health drug. Their counterparts in the Vermont AG's office have joined the action. Article

West Virginia

State of West Virginia v. Lilly West Virginia Attorney General Darrell McGraw sued Eli Lilly in February, 2006 claiming that Zyprexa harmed West Virginia citizens. McGraw's suit claimed Zyprexa sales benefited Eli Lilly at the expense of West Virginia's Medicaid program. McGraw claimed the sales would not have occurred if Eli Lilly had disclosed its risk to medical providers. He wrote, "The money paid by the State would not have been paid to Eli Lilly except for its fraudulent conduct." He asked for three times the amount of the overpayments. Article Complaint

United States

January 2004, the Office of the Inspector General for the U.S. Office of Personnel Management asked J&J for documents related to payments made to doctors in connection with sales, marketing and clinical trials for Risperdal. Article

November 3, 2005 Eli Lilly reported to the Securities and Exchange Commission that the U.S. attorney's office in Massachusetts subpoenaed the company, seeking documents on Lilly's business relationship with an unnamed long-term care pharmacy related to some of the company's drugs, including the antipsychotic drug Zyprexa. Article

November 2005 J&J's Janssen unit received a subpoena from the U.S. Attorney's Office in Philadelphia seeking information about marketing and adverse side effects of Risperdal, according to an October 2006 regulatory filing.Article

December 21, 2006 Bristol-Myers Squibb reported that it reached a tentative agreement to pay $499 million to settle a federal investigation into illegal sales and marketing activities from the late 1990s through 2005. The United States attorney's office in Boston, which first subpoenaed the records of Bristol-Myers in the matter in 2003, declined to confirm the announcement, saying it did not comment on such negotiations unless a final settlement has been signed. Jeff Macdonald, a company spokesman, confirmed previous reports that one product involved was the antipsychotic drug Abilify. Article

March 1, 2007 Congressman Henry A. Waxman, Chairman of the Committee on Oversight and Government, requested information relevant to Seroquel from AstraZeneca: "Allegations have been raised that AstraZeneca inappropriately marketed Seroquel". Subpoena

March 1, 2007 Congressman Henry A. Waxman, Chairman of the Committee on Oversight and Government, requested information relevant to Zyprexa from Eli Lilly: "Allegations have been raised that Eli Lilly misled physicians and inappropriately promoted off-label uses of Zyprexa" Subpoena

March 12, 2007 Johnson & Johnson said that it had received subpoenas from U.S. attorneys in Philadelphia, Boston and San Francisco over allegations the company marketed schizophrenia drug Risperdal for unapproved uses.Article

The Fundamental Misdiagnosis of Depression as a Disease.

As seen on the Huffington Post website,where a shrink seems to have what I call "an attack of common sense". Not that they have any thing like an effective means of treatment yet.

On the other hand, I expect to find out any day now that he has lost his license because he is seems to be trying to help folks instead of profiteering. Earlier posts here have dealt with a variety of reasons why it is so much easier for shrinks to just dope people up instead of helping them heal.

If forced to choose between labeling immobilizing depression as either a character weakness or a disease, it's understandable that disease would be the preference. But there is a third choice, one that normalizes depression and which -- for people such as myself -- feels more respectful and better reduces suffering.

I regularly do battle with right-wing talk show hosts who mock depression sufferers as crybabies. Fundamentalist pull-yourself-up-by-your-bootstrap yappers are often heartless and uninformed, and I tell them just that. However, fundamentalist depression diseasers also need to be confronted.

"I have written a polemic, an insistent argument for the proposition that depression is a disease," is how psychiatrist Peter Kramer describes his Against Depression (2005). Kramer argues that depression must be a disease because of how devastating it is. He is certainly correct that depression can result not only in suicide but can ruin careers, destroy families, and stress the body so as to jeopardize physical health.

However, such nondiseases as war and poverty also have a devastating impact; and there is a long list of noncontroversial illnesses, including the common cold, that do not have a devastating impact.

Kramer's other disease arguments are just as shaky. According to Kramer, biological markers -- the sine qua non of disease -- for depression have been discovered. He tells us that brain scanning techniques focusing on the size of the hippocampus and amygdala can differentiate the depressed from the nondepressed.

However, five months after Against Depression was published, The New York Times ("Can Brain Scans See Depression?" October 18, 2005) concluded: "After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders based on imaging studies."

Kramer also proclaims, "Deplete serotonin, and depression is unmasked." But researchers have depleted serotonin, and it did not cause depression in nondepressed subjects nor did it worsen the depressive symptoms of those already depressed.

By 1998 The American Medical Association Essential Guide to Depression had reported that there is no clear link between levels of serotonin and depression, "as some depressed people have too much serotonin."

Finally, Kramer tells us about the defective genes of depressives, "By the mid-1990s, scientists had identified genes that might lead to both conditions, neuroticism and depression." Kramer leans heavily on behavioral geneticist Kenneth Kendler; however, two months after the publication of Against Depression, Kendler reviewed the evidence for "gene action in psychiatric disorders" in the American Journal of Psychiatry (July 2005), where he concluded: "Although we may wish it to be true, we do not have and are not likely to ever discover 'genes for' psychiatric illness."

While symptoms of depression can be caused by a variety of medical conditions (for example, anemia and hypothyroidism), such medical conditions, according to the American Psychiatric Association, actually rule out the psychiatric disease of "depression."

What psychiatrists call depression has not in fact been linked to any biochemical markers.

Depression is neither a character defect nor biochemical defect but rather a strategy to shut down overwhelming pain. Used in excess, it can lead to immobilization and greater pain.

Depression is by no means the only strategy people use to shut down overwhelming pain. People use alcohol, marijuana, television, food, gambling, and worse. A depressed Sigmund Freud, pained by failure, used cocaine, then turned his friends on to it, but ultimately discovered its adverse affects and rejected it. Joseph Goebbels, even more pained by failure than Freud, shut down his pain by embracing fascism; but, unlike Freud, Goebbels couldn't have cared less about the adverse effects of his strategy.

Labeling depression as a disease gives some people relief, but such labeling creates grief for others. I have met many people who have been failed by antidepressants and electroshock. They talk about the adverse physiological effects of their treatments, but they also talk about something else. By becoming compliant patients to a medical authority, they describe losing control over their lives. Depression is an experience of helplessness and hopelessness, and for these people, accepting depression as a disease makes them feel even more helpless and hopeless.

Instead of labeling depression as weakness or illness, we might better decrease depression by understanding it as a normal, albeit painful, human reaction. When we label a part of ourselves as either "weak" or "sick," we alienate ourselves from a part of who we are, and this can create even more pain. In contrast, when we accept the whole of our humanity, we are more likely to be freed up to resolve and heal the source of our pains.

Lawsuit Over a Woman’s Suicide at an Elite Private Psychiatric Hospital

Via the New York Times. The hospital, of course, is investigating and blaming one of the heirs to the woman for contributing to the suicide, even tho she was under the hospital care and custody. A long story, so here are some snippets:

Depressed and addicted to painkillers, Ms. Farrell had checked herself into the acute-care ward at Silver Hill the previous week. Records show she told the staff she was feeling better the day she died and even asked the dietitian for less garlic in her orzo, showing that she was looking ahead.

But by nightfall, Ms. Farrell had made other plans. The orderly who had been checking on her every 15 minutes found her suspended from a bathroom door, eight feet from the nurses’ station. Black Spandex pants were tied around her neck. A suicide note was in the trash.

Now Silver Hill — a 76-year-old nonprofit hospital specializing in psychiatric disorders and substance abuse — is being sued by the executor of Ms. Farrell’s estate, himself a former patient with whom she maintained a close relationship despite warnings by her doctor that she should stay away from him. The suit accuses the hospital and a psychiatrist there, Dr. Ellyn Shander, of wrongful death by failing to protect a troubled woman from herself.

The complaint, and other episodes recounted in lawsuits and police reports over the last decade, are peeling back the veil on life inside one of the country’s more prominent psychiatric institutions and raising questions about how far a psychiatric hospital has to go to ensure its patients’ safety.

[...]

Victoria de Toledo, a Stamford lawyer who has twice sued the hospital, saw the situation differently. Speaking generally, she said, “It’s heartbreaking when someone goes in because they need help at a place like Silver Hill, and they come out worse than when they went in.”

In one case, Ms. de Toledo represented a patient who settled a civil case after accusing a hospital employee with a long criminal record of sexually assaulting her while she slept. And in a case settled for an undisclosed amount in August, she was the lawyer for a man who had his ear partly bitten off by another patient in 2003.

[...]

In the months before the trial, lawyers for the hospital and for Dr. Shander fought to obtain Mr. Kervick’s psychiatric records in an effort to shed light on his relationship with Ms. Farrell.

Judge Thomas L. Nadeau acknowledged that some records might be relevant, although he displayed concern that the information might be used to smear Mr. Kervick. “What jury would want to give money to the beneficiary of an estate who is then portrayed as a bad guy, even if his bad-guyness didn’t impact her conduct?” he asked.

Neal P. Rogan, a Westport lawyer who once defended a man charged with abetting his wife’s suicide, though not involved in this case, said the judge’s concern was legitimate. “If the jury actually followed the law,” he said, Mr. Kervick would win his case because “even if you might not like the fact that he’s the one in the will, they’re the ones charged with her care.”

Case against psychiatrist unfolds - Shrink accused of molesting patients at Gwinnett clinic

As seen in the report, more than one doctor has had disciplinary problems at this fine facility. From the Atlanta Journal Constitution

Dr. Mohammad Qureshi seemed typical of the psychiatrists at Georgia's state mental hospitals.

He was young, with just a few years' experience. He trained at a foreign medical college. And he was willing to work for the relatively low pay the state offers to those who treat the extremely difficult patients who occupy its psychiatric facilities.

But for five months this year while working at Northwest Georgia Regional Hospital in Rome, Qureshi was under suspicion for sexually molesting patients on his second job 90 miles away.

Still, he continued seeing patients at the state hospital until police arrested him in late September. At least 12 women have told authorities that Qureshi fondled them during psychiatric examinations at a Gwinnett County clinic.

The psychiatrist's arrest prompted an investigation at Northwest Georgia Regional. But no patients there made allegations against him.

"There is no evidence of any misconduct by Dr. Qureshi," said Kenya Bello, a spokeswoman for the Department of Human Resources, which runs the state hospitals.

Qureshi, 45, of Lawrenceville has pleaded not guilty. He is free on bond, awaiting trial on sexual assault charges, facing the possibility of years in prison. DHR fired Qureshi from Northwest Georgia Regional, and the state medical board could suspend or revoke his license.

The case is playing out as officials face questions about the quality of medical care in the seven state psychiatric hospitals.

The U.S. Justice Department is investigating whether poor care in the facilities violates the civil rights of patients. Meanwhile, a panel appointed by Gov. Sonny Perdue is examining the role of the hospitals' staff physicians in creating and sustaining dangerous conditions, among other issues surrounding mental health care in Georgia.

The inquiries followed articles in The Atlanta Journal-Constitution reporting that at least 115 patients died under suspicious circumstances from 2002 through 2006, many after questionable medical treatment.

Qureshi's lawyer, Andrew Margolis, did not respond to requests for an interview. He proclaimed his client's innocence at a hearing last month.

Qureshi, a native of Pakistan, is a U.S. citizen, according to his state personnel records. He graduated from Sindh Medical College at the University of Karachi in 1986 and trained at the University of Connecticut from 1999 to 2003. Files on his medical licenses in New York and Georgia do not show where he practiced during the 13-year interval.

Qureshi came to Georgia in 2006 after working for 19 months at a state mental hospital in Ogdensburg, N.Y., on the Canadian border.

At the St. Lawrence Psychiatric Center, hospital administrators received no complaints about Qureshi's behavior, said Dr. Hari Sanghi, the clinical director.

"Nothing," Sanghi said. "We don't have any adverse record on him. He was doing his job properly. We did not see any problems."

Qureshi left the New York hospital, Sanghi said, to be near his parents after they moved to Georgia.

He went to work at Northwest Georgia Regional in November 2006. His annual salary was $108,000 for a 32-hour work week — a significant cut from the $145,000 a year he earned in New York.

About the same time, Qureshi took a second job with the Gwinnett-Rockdale-Newton Community Service Board, which operates several mental health clinics in three counties outside Atlanta.

In April, according to recent court testimony, two female patients at the community service board's Lawrenceville clinic complained that Qureshi had touched them inappropriately. The board's director warned Qureshi but kept him on the staff, a police detective testified.

Qureshi's personnel file does not reflect whether anyone at the community service board notified state officials about the allegations. In fact, the file makes no mention of Qureshi's second job in Rome.

By September, complaints about Qureshi had escalated.

A 43-year-old woman alleged that during a psychiatric session, Qureshi had instructed her to disrobe and then fondled her. Over the next few weeks, 11 more women came forward to Gwinnett authorities with similar allegations.

Northwest Georgia Regional suspended Qureshi shortly after his arrest on Sept. 28. He remained on the state payroll until Oct. 22, three days after a Gwinnett County magistrate judge bound the case over to Superior Court for trial.

State personnel officers thoroughly checked Qureshi's background and credentials before hiring him, said Bello, the DHR spokeswoman. Sanghi, who was Qureshi's supervisor in New York, said he gave him a positive recommendation when Georgia officials called for a reference.

Past ethical lapses do not necessarily disqualify physicians from working in Georgia's state hospitals.

At least five doctors now employed in the facilities were hired despite having been disciplined for drug abuse. Another had temporarily lost his license because of alcohol use. Yet another had been punished for sexual misconduct with two of his patients at a private psychiatric hospital.

Therapist to pay $800,000 in damages

Another case where the penalty is possible not heavy enough. From the Billings Gazette.

A district judge on Thursday approved an $800,000 settlement agreement in a lawsuit filed by a Billings woman against her daughter's psychologist.

Judge Susan Watters said the settlement amount was reasonable considering the damages that Betty Bowman suffered from her family's association with Constance Reynolds, a therapist whose license was revoked in 2004.

Bowman's daughter, Dana Mobley, was a client of Reynolds when the two became lovers. Mobley later died while living with Reynolds.

After the hearing Thursday, Bowman said the settlement brings little relief to a difficult period in her life. Her daughter died in February 2004, and her husband died six months later. She filed the lawsuit against Reynolds in 2005.

"It's hard," Bowman said outside the courtroom. "Losing my whole family and being financially embarrassed. You believe in somebody and trust somebody and then have them turn you upside down and backwards."

In the lawsuit, Bowman claimed the psychologist was negligent and committed malpractice, fraud and identity theft when she began a sexual relationship with her daughter while treating her as a client. The lawsuit stated that Mobley died in part because of medications Reynolds improperly gave to her.

Reynolds, who now lives in Florida and represented herself in the lawsuit, could not be reached Thursday for comment. She did not attend the hearing Thursday.

Despite the settlement, the legal case is not over. Chicago Insurance Co., which provided Reynolds with malpractice insurance, has filed a federal lawsuit against both Reynolds and Bowman, stating that Reynolds' policy does not cover the claims made by Bowman against Reynolds.

Bowman's attorney, Brad Arndorfer, said a judge is expected to rule on the issue early next year.

Reynolds was sued by two other Billings residents, Kelli Van Laanen and Kay Easterling. The women accused Reynolds in separate lawsuits of professional malpractice.

Easterling was in a relationship with Mobley when Mobley and Reynolds began dating. Easterling's lawsuit was settled last year; terms of the settlement were not disclosed.

Van Laanen's case was recently resolved with an agreement by Reynolds to pay Van Laanen $100 a month for three years. If Reynolds fails to make the payments, the agreement states, Van Laanen can seek to collect $80,000 in damages.

Befoare the lawsuits were filed, a state administrative law judge found that Reynolds had an inappropriate relationship with Mobley and recommended the psychologist lose her state license. The Montana Board of Psychology unanimously followed the recommendation in June 2004.

At the hearing Thursday, Missoula psychologist Janet Allison testified by telephone that Reynolds violated her ethical duties to Bowman, who she said trusted Reynolds to care for her daughter.

In a report prepared last year, Allison described Reynolds' actions as "a tragic example" of the harm an unethical psychologist can cause.

"In my three decades of work in the field, I have never seen a more egregious case of professional violations of ethics or of damage inflicted on clients by a psychologist," Allison wrote.

Bowman testified Thursday that she deeded a house to Reynolds so Reynolds and her daughter would have a safe home to share. Reynolds then took out a mortgage on the home, Bowman said, and never paid her the full price of the house.

Bowman said she loaned Reynolds $10,000 on one occasion and was not repaid, and Reynolds used her credit cards without her permission or knowledge. One credit card debt grew to $13,000, Bowman said, and her credit rating was destroyed as a result.

Bowman told the judge that her husband died six months after her daughter. Although he suffered a terminal illness, Bowman said she believes her daughter's death hastened her husband's death because the two were very close.

After the hearing, Bowman said she still believes Reynolds played a role in her daughter's death, but no criminal investigation was ever conducted. An autopsy found that Mobley died of asphyxiation while heavily drugged.

Arndorfer represented all three women in their lawsuits against Reynolds. He said Reynolds is not practicing psychology in Florida, but may be working as a teacher.

Study finds Ritalin of no long-term benefit

Report from the Guardian

A team of American scientists conducting the Multimodal Treatment Study of Children with ADHD (MTA) has found that over a three-year period drugs such as Ritalin and Concerta brought about no demonstrable improvement in children's behaviour. They also found the drugs could stunt growth.

Research released today raises questions about the long-term effectiveness of drugs used to treat attention deficit hyperactivity disorder (ADHD).

[...]

The research, which will be broadcast on the BBC Panorama programme tonight, shows that GPs in the UK prescribed ADHD drugs such as Ritalin and Concerta to around 55,000 children last year – at a cost of £28m to the NHS.

The MTA's warning about ADHD drugs constitutes something of a revised opinion. The scientists, who have been monitoring the treatment of 600 children across the US since the 1990s, concluded in 1999 that, after one year, medication worked better than behavioural therapy for ADHD. This finding influenced medical practice on both sides of the Atlantic and prescription rates in the UK have since tripled.

The report's co-author, Professor William Pelham, of the University of Buffalo, said: "I think we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn't happen to be the case.

"The children had a substantial decrease in their rate of growth, so they weren't growing as much as other kids in terms of both their height and their weight. And the second was that there were no beneficial effects - none.

"In the short run [medication] will help the child behave better, in the long run it won't. And that information should be made very clear to parents."

Dr Tim Kendall, of the Royal College of Psychiatrists, who is helping prepare new NHS guidelines for the treatment of ADHD, said: "A generous understanding would be to say that doctors have reached the point where they don't know what else to offer.

"I hope we will be able to make recommendations that will give people a comprehensive approach to treatment and that will advise about what teachers might be able to do within the classroom when they're trying to deal with kids who have difficult problems of this kind.

"I think the important thing is we have a comprehensive approach that doesn't focus on just one type of treatment."

The new treatment guidelines will be published next year.

• Panorama: What Next for Craig? will be broadcast on BBC1 tonight at 8pm.

Prescription Drug Companies Fined - Drug Companies Ordered To Pay $13.6 Million In Pricing Suit

As seen in this report

A federal judge has ordered drug companies AstraZeneca and Bristol-Myers Squib to pay a combined $13.6 million in a Massachusetts case that alleged they inflated the so-called "average wholesale price" of expensive, and sometimes life-saving, drugs.

U.S. District Court Judge Patti Saris found that the companies "unfairly and deceptively caused to be published false" average wholesale prices of drugs.

As a result, Saris wrote in a judgment dated Thursday, the companies caused "real injuries to the insurers and the patients who were paying grossly inflated prices for critically important, often life-sustaining drugs."

Bristol-Myers Squib said its pricing was fair and it will appeal.

Saris ordered AstraZeneca to pay $12.9 million and Bristol-Myers Squib to pay $695,594 in damages. Those affected by the ruling include insurers who reimbursed Medicare beneficiaries for their co-insurance, and insurers and consumers who made co-insurance payments based on the average wholesale price.

"Bristol-Myers Squib has long maintained that it is not responsible for the averaage wholesale price reimbursement benchmark used by private insurers and Medicare and that its own pricing, sales and marketing practices were fair and reasonable. The company maintains this position and will appeal this decision," said company spokeman Tony Plohoros.

A call to AstraZeneca was not immediately returned on Friday night.

Saris said she decided to double the damages because the conduct was willful on the part of the companies.

"The defendants well understood the devastating impact the mega-spreads had on old and sick patients required to make co-payments they could ill afford," Saris wrote.

Steve Berman, lead counsel for the plaintiffs, praised the decision. "Judge Saris agreed with our damage estimates and did not pull punches in her characterization of the defendants' actions," he said.

Berman said the court has indicated that plaintiffs could expand this case to a nationwide class action lawsuit. The state class action suit was originally filed in 2002 in U.S. District Court in Massachusetts and named 23 pharmaceutical companies. The original suit represented all people who had taken or paid for any one of 37 named drugs.

Psychiatrist charged again - accused of sex assault involving adolescent patient

From the Journal Sentinel Online

A psychiatrist serving four years of probation for having a large collection of child pornography in his downtown Milwaukee apartment was charged Tuesday with sexually assaulting an adolescent patient in a Brookfield counseling center where he formerly practiced.

Eric B. Schwietering was charged in Waukesha County Circuit Court with sexual assault of a child under 16, a felony, in a criminal complaint that says the assault occurred between September 2005 and November 2006 when he was still associated with Cornerstone Counseling, 16535 W. Blue Mound Road.

The complaint says that the matter came to light recently when the boy, now 14 and living in Iowa, told his mother and a school official that he was assaulted by Schwietering, who specialized in treating children and adolescents. The complaint does not indicate why the boy was seeing Schwietering but does say that he saw the psychiatrist regularly for several months.

During one of the appointments, according to the boy, Schwietering questioned him about his sexual habits and asked him to disrobe, the complaint says. When the boy declined, according to the complaint, Schwietering climbed on top of him, partially disrobed him, then sexually assaulted him.

After the assault, Schwietering, now 41, told the boy not to reveal what occurred, warning that if he did so he would "hurt him really bad," the boy told police, according to the complaint.

In May, Schwietering was placed on four years of probation in Milwaukee County Circuit Court on two felony counts of possession of child pornography.

As part of his sentence, Schwietering, who pleaded guilty to the charges in February, was ordered to serve 45 days in jail.

That case stems from a raid in September 2006, when police seized more than a hundred pornographic video cassettes and DVDs, Schwietering's computer, and pipes and metal screens commonly used to smoke crack from a home in the 400 block of N. 3rd St. in Milwaukee.