Psychiatric patient kills himself at Novant Health Presbyterian Medical Center in Charlotte, North Carolina

From the Charlotte Observer

A patient at Novant Health Presbyterian Medical Center killed himself in the seventh-floor psychiatric unit April 6, according to Charlotte-Mecklenburg police.

The incident involved a 56-year-old Rock Hill man about 4 a.m. on the Monday after Easter. Police investigated and concluded the man committed suicide, according to the April 6 incident report.

The man’s death comes 16 months after another Presbyterian patient attempted suicide by jumping out a window on the same unit. The 25-year-old man suffered broken bones but survived.

The latest incident was reported by Novant Health to the state’s Division of Health Service Regulation, said Alexandra Lefebvre, a spokeswoman for the N.C. Department of Health and Human Services. She said details are not released until an investigation is completed.

Naturally, Novant Health issued a generic statement asserting that they follow the best practices, they are taking things seriously, etc.

Congressional hearing reveals 4 more deaths at Tomah, Wisconsin, VA Hospital

Selections from this report on the Reveal website

Four more veterans died under suspicious circumstances than previously reported at the U.S. Department of Veterans Affairs hospital in Tomah, Wisconsin, under the leadership of its chief of staff, psychiatrist Dr. David Houlihan. The deaths, revealed in a rare congressional field hearing today in the small Wisconsin town, bring to 33 the number of unexpected deaths The Center for Investigative Reporting has found occurred during Houlihan’s decade at the helm. The medical center became known as “Candy Land” for the ease with which narcotic painkillers were prescribed.

They include Kraig Ferrington, a 45-year-old Army veteran and union plasterer who died of an overdose of seven medications prescribed by Houlihan in 2007, and three veterans that a VA pharmacist told lawmakers died in the VA parking lot in 2008 and 2009.

“We are doing everything we can to make sure these tragedies don’t happen to others,” Sen. Ron Johnson, chairman of the Senate Committee on Homeland Security and Governmental Affairs, told a packed audience of 400 veterans and family members at the Cranberry Country Lodge. The hearing brought together many of the people who had suffered and complained for years about Houlihan’s practices to no avail. Members of Congress from both parties made the trip to the rural community, which had until recently been more famous for cranberries and cheddar cheese than notorious for narcotic painkillers.

[...]

Today’s hearing marked the sixth congressional hearing where overmedication and abuse of authority at the Tomah VA have been discussed since CIR revealed the problems in a story published Jan. 8.

[...]

Within a week of that story’s publication, Houlihan and Frasher were removed from their positions pending the completion of an internal investigation.

On March 10, they were placed on administrative leave after a preliminary review found that Tomah patients were 2.5 times more likely than the national average to receive high doses of opiates. On March 20, the VA told Congress that Houlihan’s boss, Tomah hospital Director Mario DeSanctis, had been “reassigned to a position at the Great Lakes Health Care System network office, a position outside of the medical center.”

The VA Office of Inspector General, the Wisconsin Department of Safety and Professional Services and the U.S. Drug Enforcement Administration also have opened fresh investigations of Houlihan and the Tomah VA.

Throughout the three-hour hearing, lawmakers expressed exasperation that few alternatives to narcotics are being offered. Rep. Tim Walz, D-Minn., an Army veteran, said he had been pressing the VA to adopt a more nuanced approach to pain management since 2008. [...]

Witnesses included Ryan Honl, a Gulf War veteran and West Point graduate; Noelle Johnson, a pharmacist who was fired in 2009 after she refused to fill prescriptions for high doses of morphine that she believed were unsafe; and family members of those who died, including Heather and Marvin Simcakoski, the widow and father of Jason Simcakoski, a 35-year-old former Marine who died of an overdose in the Tomah VA psychiatric ward in August.

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

From a report in the Alaska Dispatch News

More details at the link

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[...]

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

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

[...]

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

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

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

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

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

Psychiatry is Broken

A very interesting blog post slash column entitled "When Psychiatrists Distrust Their Patients, Their Patients Can Only Respond In Kind" by Rebecca Vipond Brink

She reviews the problems she has had with Psychiatrists when they become arrogant, and do not take seriously what their patients are saying. Unfortunately this is all too common.

Here are some snippets

The worst psychiatrist I had, on the other hand, seemed awesome when we started — our initial appointment was an hour long, and she probed into my family’s medical history for clues about mine. It seemed holistic. As time went on, though, appointments became sparser and shorter — she was constantly double-booked, she got to the point that she was doing five-minute refill appointments, and I was eventually on four different medications in an attempt to treat anxiety and what we thought was depression in the fallout of PTSD. When I disputed her original diagnosis at my last appointment, she responded, “That’s just not what I know about you from our work.” Our work? She had only spoken to me for a grand total of maybe two hours at that point, while I had been out in the world living my life with my emotions. I wanted to be trusted that I was the best possible source of information about my well-being, not a brief description of a few symptoms and the DSM-V.

I told her that I wanted to get off of my medications because they just weren’t working — I was still having massive, debilitating anxiety attacks, nightmares, insomnia, paranoia. I had had a full-on nervous breakdown while on medications. And I didn’t feel like anti-depressants were appropriate, because with a lot of reflection, I landed on the opinion that debilitating anxiety looks a lot like depression but is not the same thing. All of my feelings and neurotic impulses were still very intense, and yet here I was, taking more and more medications in higher and higher doses to treat them, to no effect. Instead of weaning me off of anything, she prescribed two more medications. I found out later that some of the medications she wanted me to take had unsavory interactions that she didn’t disclose to me.

[...] All of this has left me feeling more than a little suspicious about psychiatry. I felt like my psychiatrist had dismissed my opinions in her care plan, and had distrusted me and my word without me having given her any reason over the course of my treatment to do so. I felt like I had had no control over my care, and that feeling of a lack of control over what was a major part of my life was devastating — I have PTSD because of abuse and rape. Control over my body is important to me.

Much more at the the link.

Just another data point of evidence that Psychiatry is Broken

Nevada tried to save money by bussing psych patients out of state for treatment

As reported in the Las Vegas Sun

Nevada is shelling out big money to defend itself in a class action lawsuit alleging the Department of Health and Human Services misused public money and jeopardized the lives of nearly 500 mental health patients in what’s known as the Greyhound busing scandal.

The state’s board of examiners will vote today to approve a $400,000 contract extension between Nevada and a California-based law firm Bingham McCutchen to fight claims that mental health patients were discharged from hospitals, ushered onto buses and transported to various cities in California to pass off the cost of treating mental health patients.

The contract highlights the cost the state must endure in and out of the courtroom.

If approved, the contract extension will mean the state has allocated more than $1.9 million to defend itself in the suit, which was filed by the City and County of San Francisco on behalf of more than 50 California towns that were harbors for Nevada mental health patients between 2008 and 2013.

Nevada needs a California-licensed attorney to fight the case in that state, said Jennifer Lopez, a spokeswoman for the Nevada Attorney General’s Office. State officials made their case for the expense to the Legislature’s Interim Finance Committee on Monday. The committee approved the appropriations, signaling that the board will follow suit.

Court filings show that Nevada has aggressively tried to quash the case since it was first filed in September 2013.

“It was the individuals, and not the Nevada State Defendants, who took the (intervening) steps to reach California and, allegedly, seek additional medical care,” Nevada’s legal counsel wrote about the discharged mental health patients in legal filings.

Court filings also show that Nevada said that the mental health patients made “unilateral” decisions about where to go.

But a trial court and a state court of appeals said San Francisco does have the authority to charge Nevada. Nevada’s legal counsel then appealed to the California Supreme Court, which hasn’t stated whether it will hear the case.

In court filings, a San Francisco County judge painted Nevada as a state trying to save money by shifting costs to California. It said some patients were medicated when they were given bus vouchers and instructions to call emergency rooms, shelters and other treatment facilities when they arrived in California.

Between July 2007 and March 2013, Southern Nevada health officials had a policy to “assist patients” back to their home communities as a way to “remove the burden of treatment from the State of Nevada,” according to legal filings from John Munter, a San Francisco County judge.

The state was having budget problems. The Southern Nevada psychiatric hospital, Rawson-Neal, was consistently filled to capacity and understaffed. There was tremendous pressure to discharge patients, according to Munter’s filings.

Munter also wrote that Nevada “expressly targeted” California to achieve a result that would “impose financial burdens on California communities.”

“At least to some discharged patients, [Nevada] did not give [patients] any meaningful choice other than to go to California or any meaningful options to remain in Nevada,” Munter wrote. “In some instances, defendants gave referrals to medical care and housing facilities in California but not in Nevada, and advice that follow-up care was available in California but not in Nevada.”

The lawsuit alleges that Nevada’s busing practice forced California to misappropriate resources.

It cost the City of San Francisco $4 million to treat 21 Nevada patients who were bused into the state.

Of those 21 patients, more than half had no prior relationship with the state of California, according to court records.

And San Francisco wasn’t alone. Patients popped up in Sacramento and 50 other California cities.

The total cost for the whole state is still unknown.

At home, Nevada has done its best to repair the state’s mental health system.

From 2007 to 2011, the Legislature cut $80 million from the mental health budget.

Gov. Brian Sandoval has made efforts to make up for the losses and the nefarious spotlight that flung to the state when the busing scandal first made headlines. He’s done so alongside Mike Willden, Sandoval’s current chief of staff and former health department director listed as a defendant on the lawsuit.

They have boosted mental health funding by at least $30 million, and Sandoval signed an executive order to create the Behavioral Health and Wellness Council to oversee state programs and make recommendations. Since June, it has advocated for and Sandoval has awarded at least $3.5 million in state funding. More than 100 beds for mental health patients have been added to hospitals statewide.