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

A Sad story of a woman trying to get help, and the failure of the psychiatric system in here city to help.

Snippet from a much longer story

The HSE has said it is to investigate concerns raised by a well-known Limerick businesswoman after she experienced "hell on earth" in a psychiatric hospital unit in Limerick.

Last November, Leona O'Callaghan, 35, spent two months at the 5B Psychiatric Ward in University Hospital Limerick, which she described as a "violent" and "uncaring" place.

"The HSE need to hear the voice of the service users," the mother of three said.

Ms O'Callaghan said she was forced to speak out publicly about her experience, because she got "no reply" to letters she sent to the Minister for Health, Leo Varadkar, and his Junior Health Minister, Kathleen Lynch.

In a searingly honest interview she described how after approaching a nurse in 5B, she was told she should kill herself if she really wanted to.

[...]

"There's an epidemic in suicide in Limerick. Obviously something is going wrong."

Florida Psychiatrist Mark Agresti sued over treatment of West Palm Beach woman who killed daughter and herself

Here is the Local TV WPBF News Reports



with this related report

Bradley Brooks was so concerned about his 10-year-old-daughter Alexandra, on Sept. 12, 2013, he asked the police to check the home she shared with her mother Pamela Brooks. Police went to the home located at 139 Gregory Place and found Alexandra and Pamela inside, both stabbed to death. Pamela Brooks was found with 130 self-inflicted stab wounds. Her daughter was found with 30 stab wounds. Police ruled the case a murder-suicide.

The girl's father is now suing a psychiatrist and a substance abuse counselor who were treating Pamela Brooks.

According to the lawsuit, Pamela Brooks had a lifetime of alcohol abuse. Beginning in 1999 her alcohol abuse began causing problems in her life. The lawsuit also states, Bradley Brooks filed an emergency request for custody of their daughter back in May of 2013, just weeks after her mother was arrested for DUI. The lawsuit states, Pamela Brooks was ordered to a comprehensive psychological evaluation and was seen several times by the doctor. Her next scheduled appointment was for Sept. 13, 2013. She and her daughter were found dead inside their home Sept. 12, 2013.

According to the lawsuit filed last week, Brooks doctor is accused of "Failing to clearly communicate that Pamela Brooks was at risk of inflicting harm to herself or to others," and "Failing to refer Pamela Brooks to a physician trained in the management of patients suffering from severe depression," the suit states.

Both the doctor and counselor are accused of negligence.

And as reported in the Palm Beach Post

A psychiatrist and a substance abuse counselor who were treating a West Palm Beach woman who killed herself and her 10-year-old daughter in September 2013 have been sued in connection with the deaths that stunned the community. In the lawsuit filed last week in Palm Beach County Circuit Court, family members of Pamela and Alexandra Brooks blame Dr. Mark Agresti and counselor David Dashev for the murder-suicide.

The two “knew or should have known that Pamela Brooks was at risk of inflicting harm to herself, or to others,” according to the lawsuit filed by attorney Glenn Crickenberger, who works for the Stuart law firm of famed lawyer Willie Gary. “However, (they) failed to refer Pamela Brooks to a physician trained in the management of patients suffering from severe depression.”

Brooks, 48, was found dead in the living room of her Gregory Place home with 130 self-inflicted stab wounds. The body of her daughter was found in the kitchen with 30 stab wounds, the suit says. The deaths so shocked the community that the city’s then police chief took the unusual step of calling a press conference to announce they had been ruled a murder-suicide. The grisly scene was discovered by Brooks’ ex-husband, Bradley, who broke into the home because he was concerned about his daughter, a King’s Academy student.

Dashev, former chief operations officer of the Mental Health Pavilion at what is now West Palm Hospital, declined comment on the suit. Agresti couldn’t be reached.

Pamela Brooks had been ordered to seek treatment from Agresti and Dashev by Circuit Judge Thomas Barkdull in May 2013 after Bradley Brooks filed an emergency request for custody of the couple’s daughter. The request came weeks after Pamela Brooks was arrested for driving under the influence.

The lawsuit, filed on behalf of Bradley Brooks and his ex-wife’s parents, Martin and Evelyn Hewson, details Pamela Brooks long struggle with alcohol abuse. It also indicates she initially responded to treatment by Agresti and Dashev. Treated daily with Antabuse, a drug designed to reduce cravings for alcohol, medical records in June and July 2013 showed she was “compliant and that her spirits were good,” the lawsuit says.

In August, the tenor of the notes changed. They indicate she had resumed drinking. Questions were raised about whether she needed residential care. “There was a discussion with Ms. Brooks regarding depression and the presence of suicidal ideation,” the suit says.

From Aug. 16 to Sept. 6, 2013, she was seen about 10 times by Agresti and Dashev. “During several of these visits Pamela described her overall condition as being characterized by anxiety and tension,” the suit states. “She described herself as feeling overwhelmed, angry and upset stemming from her DUI and all the changes in her life that the DUI has caused.” A day before her next appointment, she killed herself and her daughter.

The suit accuses Agresti and Dashev of negligence. It seeks an unspecified amount in damages.

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.

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.

[...]

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

From an extended report from the Arizona Daily Star

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

Many more details at the link

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

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

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

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

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

[...]

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

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

[...]

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

[...]

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

Smoking Cessation Drug Suspected in 30 Suicides in Canada

From a Report in the Vancouver Sun

Champix is suspected of playing a major role in the deaths of 44 patients — 30 of them by suicide — since the popular stop-smoking drug was approved in Canada in 2007, a Vancouver Sun investigation has found.

The Pfizer drug has also been linked to more than 1,300 incidents of suicide attempts or thoughts, depression, and aggression/anger across the country in the past seven years.

The drug is the most popular of those offered by B.C.’s quit smoking program, which traditionally sees a jump in participation every January as people renew new year’s resolutions to butt out.

Numbers on the deaths and other side-effects come from a Health Canada database where doctors, pharmacists and drug companies report bad side-effects experienced by patients taking pharmaceuticals.

But Health Canada admits on its website that side-effects are under-reported, and experts say the database could represent as little as one per cent of the patients who suffer complications.

“A small proportion of the adverse reactions that have occurred on this drug in Canada would be in the adverse reaction database. Essentially it is spontaneous, voluntary reporting,” said Barbara Mintzes, a pharmaceutical drug expert at the University of B.C.

Even the incomplete numbers, though, are a concern, she said. When someone taking an anti-depressant attempts suicide, it’s initially not clear whether that’s caused by the pre-existing depression or the drug; but in the case of Champix, people are taking the drug to stop smoking — not for a mental health condition.

“You are looking at a lot of deaths, suicides and attempted suicides, and suicidal ideation in a population that you would have no reason to think would be otherwise at high risk of suicide,” said Mintzes, an associate professor in the Faculty of Medicine’s School of Population and Public Health.

The Sun downloaded data from the Health Canada site for Champix and Zyban, the two drugs covered by Pharmacare as part of the province’s Smoking Cessation program.

Champix is the subject of a class-action lawsuit, which more than 200 Canadians have joined, alleging psychiatric side-effects. One of the plaintiffs is the mother of a B.C. woman who killed herself while she was on the drug.

In recent years, Champix has been slapped with the toughest safety warnings in the U.S. and Canada, and France stopped covering the drug through its public Pharmacare system.

Much more information at the lihnk

In 2000, a study was done in which 20 healthy non-depressed volunteers were given the SSRI antidepressant Zoloft (Sertraline). Two weeks into the study two volunteers became dangerously suicidal.

As reported in the Guardian on Sunday 21 May 2000

Much more info at the link

Alarming evidence from a new British study shows that the Prozac class of antidepressants can make healthy men, women and children with no history of depression feel suicidal.

The research undermines the claims of Eli Lilly, makers of Prozac, that people who kill themselves while on the tablets do so because of their depression, and that the disease, not the drug, is to blame for their suicide.

Its findings are particularly worrying because of the increasing numbers of people, including children, who are being given the drugs by their GP for mild depression, and who are not seriously clinically ill.

[...]

It found that two out of 20 healthy volunteers on an antidepressant in the Prozac class called Lustral (or Zoloft in the USA) became dangerously suicidal, compared with none of them when they were put on an antidepressant of a different class called reboxetine.

One 30-year-old woman who took part had a nightmare about having her throat slit after one week and by the end of a fortnight, was suicidal. "She felt hopeless and alone. It seemed that all she could do was to follow a thought that had been planted in her brain from some alien force. She suddenly decided she should go and throw herself in front of a car, that this was the only answer.

"It was as if there was nothing out there apart from the car, which she was going to throw herself under. She didn't think of her partner or child," says the study, published in the journal Primary Care Psychiatry.

Later she completed a diary entry, describing herself as jumpy, anxious and suspicious. "Her mind was racing and spiraling out of control. Then it went blank except for the clear thought that she must kill herself violently by throwing herself beneath a car or a train."

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.

Family of man who harmed himself to appeal in malpractice suit against the Vancouver Island Health Authority, an emergency-room physician and psychiatric nurse.

From a report in the Times Colonist

An appeal has been filed by a man and his family who lost a malpractice lawsuit against the Vancouver Island Health Authority, an emergency-room physician and psychiatric nurse.

Joseph Briante, represented by his mother, Carol Briante, had filed the malpractice suit alleging that a psychiatric nurse and emergency-room doctor who saw Briante failed in their psychiatric assessment and treatment.

Briante was a lawyer whose life began to spiral downward in the summer of 2007. By October, his mental health was deteriorating rapidly.

On Oct. 29, 2007, he became delusional and paranoid, and feared being monitored, sacrificed or killed, his family said in court documents.

His family rushed him to Royal Jubilee Hospital’s psychiatric emergency service. They arrived at 4:50 p.m. and Briante told the triage nurse he felt as if he was having a nervous breakdown.

Briante was discharged at 7:30 that night without seeing the on-call psychiatrist. He was referred to outpatient counselling. In a psychotic state six days later, he slashed and stabbed himself in the neck and arm with a knife, resulting in severe blood loss and cognitive impairment. He is now unable to live independently.

[...]

Briante’s family — mother Carol, father James and brother-in-law Carter Hovey — have asked the court of appeal to find that the negligence was the cause of Briante’s injuries and therefore the cause of the expense of caring for Briante and the harm the family endured.

That harm includes the psychological injury and trauma Briante’s family members experienced when the father and Hovey tried to hold him down while his mother attempted to administer mouth-to-mouth resuscitation.

A former Fogelsville (Pennsylvania) psychiatrist who failed to show up for sentencing this week in his pill-mill case was found dead Thursday afternoon.

From a longer report in the Morning Call

Dr. David Daley, 59, was found along the Susquehanna River just east of the Maynard Street Bridge in Williamsport, Lycoming County Coroner Chuck Kiessling said.

"It appears to be a self-inflicted gunshot wound," Kiessling said. He ruled the death a suicide.

Daley was facing the possibility of more than 20 years in a state prison for breaking prescription medication laws and providing drug addicts with easy access to painkillers.

His attorney, Kathryn Roberts, said his family was distraught over the news.

Police had searched for Daley on Wednesday night and Thursday morning. They said he was emotionally unstable and had a revolver. "This is just a tragedy for his family," Roberts said.

[...]

A jury Sept. 26 found Daley guilty of 16 drug-related charges. State sentencing guidelines called for a sentence of 22 to 36 months for most of those counts. Ford could have sentenced Daley separately for each, or run them concurrently, allowing Daley to serve them all at the same time.

[...]

Roberts said she did not know where Daley got the gun. As far as she and his family knew, he did not own a firearm, she said.

During the two-week trial, state Deputy Attorney General Christie Bonesch presented witnesses who said Daley gave them prescriptions without performing physical exams or taking a medical history. In one 11-day period, the prosecutor told the jury, Daley prescribed one patient 1,320 oxycodone pills and 500 tablets of the anti-anxiety drug Xanax.

[...]

Daley was arrested in January 2013 on a recommendation from a statewide grand jury that heard testimony in 2010 and 2011. Prosecutors from the state attorney general's office said the crimes occurred between Jan. 1, 2008, and Dec. 17, 2009, when Daley had a home office at 7729 Main St., Fogelsville.

Daley was initially charged with crimes related to 28 patients. Prosecutors withdrew counts related to 12 patients during the trial, and Daley was convicted on all charges related to the remaining 16.

[...]

The Top Ten Reasons Psychiatrists Get Sued

This is the text of a paper/talk presented at a conference on medical malpractice in Texas in 1993, and is focused on Texas Law.

How I Decided to Sue You: Misadventures in Psychiatry

It is an interesting read, but is 24 pages long, including cover sheet, etc.

As a quick summary, The top ten reasons psychiatrists get sued are

A. Failure to Prevent Suicides or Self Inflicted Injuries
B. Sex with the Sick
C. Informed Consent (or lack thereof)
D. Inappropriate Administration of Electro Convulsive Therapy
E. Inappropriate Use or Non Use of Physical or Chemical Restraints
F. Liability for Locking Them Up
G. Injuries Resulting from Escapes or Elopements
H. Medication Errors
I. Failure to Diagnose Intracranial Lesions
J. the Psychiatrist Duty to Warn Third Persons

Overall, an interesting read. This is a PDF Document

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.

Psychiatrist in Murder Suicide

A report from Beirut, Lebanon

A psychiatrist committed suicide Wednesday morning after shooting dead a father and his two daughters.

Jack Hreiki, a 42-year-old psychiatrist, shot a 26-year-old lawyer, Chantal Ghanem; her sister Cheryl, a 29-year-old accountant; and their father Ghassan, a 58-year-old engineer; in the town of Batroumin in the northern province of Koura.

The victims were on their way to work in Tripoli when they were shot with a pump-action shotgun.

Hreiki, whose fellow townsmen described as a "psychiatrist in need of a psychological assistance," then went home and committed suicide.

A security source told The Daily Star that Hreiki knew his victims, as he was in love with Chantal, who had rejected him, for three years.

The source said Hreiki waited for the Ghanem family to leave for work, and when he blocked their path carrying a shotgun, the father stepped out from the car in an attempt to dissuade him from shooting. Ghassan was targeted first.

Hreiki then shot and killed the man's two daughters, who had witnessed the first shooting from the car.

Hreiki had repeatedly threatened Chantal, the sources said, and the Ghanem family had alerted the Internal Security Forces.

The homicide is the third this month [...]

If You Think There is a Risk Then Why on Earth Are You Releasing Him?

From the Derby Evening Telegraph

A Transcript reveals how a doctor was warned by a police inspector about the risk of releasing a patient who threatened to torch his house - 24 hours before he set himself on fire and died.

It shows Inspector Alison Dando telling psychiatrist Dr Raj Sinha that, if anything happened to Andrew Whetton, "it would look bad on the health authority".

The 48-year-old begged to be kept in hospital and threatened to set fire to his house but was released from the mental health unit.

The next day, he covered his clothes in petrol and set them alight while in a car with his partner of 25 years, Julie Croft, in Marston Lane, Hatton.

Coroner Dr Robert Hunter recorded a verdict of suicide at the end of a two-day inquest yesterday.

However, he said the fact Mr Whetton was not given a mental health examination by a senior psychiatrist after the suicide threat was a "contributing factor in his death".

Dr Sinha rang police to let them know Mr Whetton was being released.

After a recording of the call Dr Sinha made to police was played in court, he said: "Too much pressure was coming to me at that time. It was not an ideal situation.

"We do not have a machine to say what this patient will do."

[...]

Dr Robert Rowlands, an independent psychiatrist asked to look at Mr Whetton's medical notes, also questioned the decision not to carry out an assessment.

He said: "People being agitated to the point of pleading on their knees - that's an unusual level of agitation. If you have ended up on a psychiatric ward, you are a high risk.

"Dr Gupta did not actually review the patient himself. That would have been the prudent thing to do."

The inquest heard how Mr Whetton could not be sectioned under the Mental Health Act as he wanted to stay in hospital.

Summing up, the coroner said: "Mr Whetton was agitated, he fell to his knees pleading with staff not to discharge him. The team were collectively concerned to inform the psychiatrist, but no formal examination was made. The consultant psychiatrist did not see him. As a result of that decision, it was agreed he should be sent on home leave. I find that this was a contributing factor in Mr Whetton's death."

The suicide rate now is roughly where it was in 1965 despite 20 years of sticking Americans on anti-depressants

Furious season has a quick summary of a long article in the NY Times Sunday Magazine on Suicide. One tidbit of note:

I also admire his pointing out that the suicide rate now is roughly where it was in 1965 despite 20 years of sticking Americans on anti-depressants and the like, and that once some would-be jumpers are stopped, they never again try to kill themselves.

.Here's the quote from the NY times:

Then there is the most disheartening aspect of the riddle. The National Institute of Mental Health says that 90 percent of all suicide “completers” display some form of diagnosable mental disorder. But if so, why have advances in the treatment of mental illness had so little effect? In the past 40 years, whole new generations of antidepressant drugs have been developed; crisis hotline centers have been established in most every American city; and yet today the nation’s suicide rate (11 victims per 100,000 inhabitants) is almost precisely what it was in 1965.

Would it be too much to say that maybe they are not diagnosing the correct problem? That changing and rotating the tires will not fix a blown engine?

The Bizarre Case of Dr. Margaret Bean-Bayog, Harvard psychiatrist

A flash back to the bizarre case of Dr. Margaret Bean-Bayog, Harvard psychiatrist, taken from a report in the NY Times on September 18th, 1992.

Psychiatrist in Sex Abuse Case Offers Her License

Dr. Margaret Bean-Bayog, the Harvard psychiatrist who has been accused of sexually abusing one of her patients and contributing to his suicide, offered to resign her medical license today.

The offer was made four days before the state Board of Registration in Medicine was scheduled to present evidence against Dr. Bean-Bayog that could have led to the loss of her license.

After meeting tonight, members of the medical board announced that they would forward the letter and accompanying documents to the administrative judge in charge of the case for a decision on whether to go forward with the hearing on Monday, as scheduled.

But Jack Fabiano, the lawyer hired by the board to present the evidence against Dr. Bean-Bayog, called the resignation attempt "invalid" and said, "I view this as a highly improper attempt to circumvent normal trial procedures."

A member of the medical board, Paul Gitlin, said there were complications with Dr. Bean-Bayog's letter proposing her resignation, which would be permanent and would prevent her from practicing medicine anywhere in the nation. In most states, however, the loss of her medical license would not prevent Dr. Bean-Bayong from practicing as a therapist.

Continues to Declare Innocence

In her letter, Dr. Bean-Bayog continued to declare her innocence and denounced the board and the way it has treated her. Dr. Bean-Bayog said the hearing would be a "media circus" staged for "purely political purposes."

Dr. Bean-Bayog, who is 48 years old, said she wished to resign rather than endure "any further pandering to the public appetite for preposterous, salacious scandal." She specifically denounced both the state Secretary of Consumer Affairs, Gloria Larson, who has jurisdiction over the medical board, and Mr. Fabiano.

"I am not resigning because I fear the potential outcome of this hearing process," she wrote. "It is the process itself, which has already taken a heavy toll on me and my family, and not any potential verdict, that I find daunting."

Confession Unacceptable

In the last few weeks Dr. Bean-Bayog had been negotiating with the board for a settlement, but in her letter she said the board's offer to suspend her license was unacceptable because, she wrote, "It required me to confess to conduct I did not commit."

The medical board had prepared a strong case against her, people familiar with the case said, and it would have introduced evidence questioning her therapy methods and suggesting that she had become sexually involved with her patient, Paul Lozano, a Harvard Medical School student. Mr. Lozano, who began therapy with Dr. Bean-Bayog in 1986, killed himself with a large overdose of cocaine in April 1991 after she had stopped treating him.

Mr. Lozano's family has filed a lawsuit against Dr. Bean-Bayog charging her with malpractice and wrongful death. Andrew Meyer, the Lozano family's lawyer, said that Dr. Bean-Bayog's resignation would tend to help the family's case. Allegations Attract Notoriety

The case has attracted enormous national attention because of the sexual allegations and because of 3,000 pages of medical records introduced by Mr. Meyer that include sexual fantasies written by Dr. Bean-Bayog. At least two books and two television movies are in the works, and some of the hearing was to have been televised on Court TV. Officials of the state Division of Administrative Law Appeals, an independent state agency that is conducting the hearing, said they had received so many requests for press credentials that they had decided to move the proceeding to the State House auditorium, with a seating capacity of 600.

Dr. Bean-Bayog and some of her friends in the psychiatric community have said she is being unfairly singled out because she is a woman. They have argued that neither the press nor the medical board would have pursued the case so vigorously if she were a man.

Another psychiatrist, Dr. William Barry Gault, who also treated Mr. Lozano, first reported possible abuse by Dr. Bean-Bayog in late 1990. But it was not until last March, after Mr. Meyer filed 3,000 pages of evidence with the court and after the press subsequently began reporting about the case, that the medical board began its inquiry.

Sexual Fantasies Documented

Mr. Meyer's evidence included sadomasochistic sexual fantasies handwritten by Dr. Bean-Bayog, allegedly about Mr. Lozano, and flashcards she gave him.

One of the cards said: "Run over these cards every day until you know them all by heart and are starting to believe them." Another said, "I'm your mom and I love you and you love me very, very much. Say that 10 times." Still another said, "I'm going to miss so many things about you, the closeness and the need and the phenomenal sex."

Dr. Bean-Bayog has argued that these are examples of an accepted therapeutic technique called transference, in which the patient is asked to imagine the therapist as his mother.

Therapists often take patients back to their childhood to discover the source of troubling emotions. But Dr. Howard Zonana, a professor of psychiatry at Yale Medical School, said: "It is one thing if you do this in a role-playing session. It's another thing if someone's reality is getting confused. Most doctors would not actually say they are the mom."

The most serious allegations against Dr. Bean-Bayog, and those that would provide the board with its clearest cause to strip her of her license, are very hard to prove: that she sexually abused Mr. Lozano and that she contributed to his death. Dr. Bean-Bayog has denied any sexual involvement with Mr. Lozano.

Nevertheless, the board appeared ready to try to prove these accusations. Its expanded list of charges, filed in June, includes one that she "improperly conducted and utilized psychotherapy sessions." According to people familiar with the case, the board will use this to introduce testimony from several other psychiatrists who treated Mr. Lozano that he had told them she slept with him and masturbated in front of him during therapy sessions.

'Somewhat Unconventional'

On the issue of suicide, the board's charges contend that "Dr. Bean-Bayog's failure to conform to the standards of accepted medical practice caused harm to Paul Lozano." The board is expected to call expert witness on that subject.

A second difficulty is that while the medical board has charged Dr. Bean-Bayog with failing "to conform to the standards of accepted medical practice," there is widespread disagreement among therapists about the boundaries of proper psychotherapy. In one of her few public statements, Dr. Bean-Bayog acknowledged that her treatment was "somewhat unconventional," but she asserted that this was necessary because Mr. Lozano was an especially troubled patient.

Nearly 20% of the U.S. Army in Afghanistan is on Prozac

Snippets from a much larger article in Time Magazine, much of with seems to be in a factual feel good tone. The wonders of modern medicine, etc.

What is bothersome is the fact of troops coming home with a variety of mental problems to begin with, and the extended problems of nasty side effects from a large variety of psychiatric drugs. The combination of the two factors is suspicious, and certainly needs more investigation

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For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

At a Pentagon that keeps statistics on just about everything, there is no central clearinghouse for this kind of data, and the Army hasn't consistently asked about prescription-drug use, which makes it difficult to track. Given the traditional stigma associated with soldiers seeking mental help, the survey, released in March, probably underestimates antidepressant use. But if the Army numbers reflect those of other services — the Army has by far the most troops deployed to the war zones — about 20,000 troops in Afghanistan and Iraq were on such medications last fall. The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants — largely the class of drugs that includes Prozac and Zoloft — and those taking prescription sleeping pills like Ambien.

In some ways, the prescriptions may seem unremarkable. Generals, history shows, have plied their troops with medicinal palliatives at least since George Washington ordered rum rations at Valley Forge. During World War II, the Nazis fueled their blitzkrieg into France and Poland with the help of an amphetamine known as Pervitin. The U.S. Army also used amphetamines during the Vietnam War.

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And yet the battlefield seems an imperfect environment for widespread prescription of these medicines. LeJeune, who spent 15 months in Iraq before returning home in May 2004, says many more troops need help — pharmaceutical or otherwise — but don't get it because of fears that it will hurt their chance for promotion. "They don't want to destroy their career or make everybody go in a convoy to pick up your prescription," says LeJeune, now 34 and living in Utah. "In the civilian world, when you have a problem, you go to the doctor, and you have therapy followed up by some medication. In Iraq, you see the doctor only once or twice, but you continue to get drugs constantly." LeJeune says the medications — combined with the war's other stressors — created unfit soldiers. "There were more than a few convoys going out in a total daze."

About a third of soldiers in Afghanistan and Iraq say they can't see a mental-health professional when they need to. When the number of troops in Iraq surged by 30,000 last year, the number of Army mental-health workers remained the same — about 200 — making counseling and care even tougher to get.

"Burnout and compassion fatigue" are rising among such personnel, and there have been "recent psychiatric evacuations" of Army mental-health workers from Iraq, the 2007 survey says. Soldiers are often stationed at outposts so isolated that follow-up visits with counselors are difficult. "In a perfect world," admits Nash, who has just retired from the Navy, "you would not want to rely on medications as your first-line treatment, but in deployed settings, that is often all you have."

And just as more troops are taking these drugs, there are new doubts about the drugs' effectiveness. A pair of recent reports from Rand and the federal Institute of Medicine (iom) raise doubts about just how much the new medicines can do to alleviate PTSD. The Rand study, released in April, says the "overall effects for SSRIs, even in the largest clinical trials, are modest." Last October the iom concluded, "The evidence is inadequate to determine the efficacy of SSRIs in the treatment of PTSD."

Chris LeJeune could have told them that. When he returned home in May 2004, he remained on clonazepam and other drugs. He became one of 300,000 Americans who served in Iraq and Afghanistan and suffer from PTSD or depression. "But PTSD isn't fixed by taking pills — it's just numbed," he claims now. "And I felt like I was drugged all the time."

So a year ago, he simply stopped taking them. "I just started trying to fight my demons myself," he says, with help from VA counseling. He laughs when asked how he's doing. "I'd like to think," he says, "that I'm really damn close back to normal."

Patient's suicide raises questions about psychiatrist's ethics

As reported in the Pioneer Press

When people enter drug studies at the University of Minnesota, they're supposed to be protected by a safety net keeping watch that the vulnerable are not coerced, that standards of conduct are met and that researchers aren't tangled in conflicts that might influence their decision-making.

That system was supposed to protect Dan Markingson.

A schizophrenic, Markingson killed himself in 2004 while enrolled in a study at the U comparing anti-psychotic drugs. Documents surfacing the past year in a lawsuit over his death have raised questions about whether the U psychiatrist running the study followed university ethical guidelines. They also raise questions about why the Institutional Review Board, the internal group charged with protecting people in university studies, didn't intervene.

University officials say their nationally accredited review board — a volunteer panel of 57 experts in medicine and other disciplines — works well and rigorously reviews studies. They would not talk specifically about the Markingson case to the Pioneer Press. A judge ruled in February that as a state agency, the university and its IRB are immune from the lawsuit.

The legal ruling didn't allow questions to be explored about who's ultimately responsible for the safety of research subjects and whether the university did everything reasonable to protect Markingson from harm.

According to the U's human subjects protection guide, the IRB's first charge is "to protect human subjects involved in research at the university from inappropriate risk."

In reality, the IRB operates largely on trust. Trust that researchers will follow the rules. Trust that people will speak up when a safety plan is violated, even if they have professional or financial pressures to stay quiet.

"It's the people who implement the plan who are responsible for protecting the subjects," said Moira Keane, the U's director of research subjects protection programs.

The IRB approves all clinical research — modifying safety rules when necessary — and samples study records every year or so to make sure its conditions are met. It also has the power to shut down projects that aren't complying with safety requirements or have caused "unexpected serious harm" to subjects.

Keane recalled four studies out of thousands at the U over the past two decades that the IRB stopped.

The lawsuit by Markingson's mother, Mary Weiss, alleged that the IRB's trust was misplaced in the so-called CAFE study, led by Dr. Stephen Olson, a U psychiatrist.

A central allegation was whether Olson had too much power over Markingson, and too many conflicts that obscured his clinical judgment. Olson recruited Markingson into the study at the same time he served as Markingson's treating doctor and advised a Dakota County judge on whether Markingson should be committed to a psychiatric hospital.

Had the IRB followed its own guidelines, it would have discouraged Olson from recruiting his own patient. The IRB Web site states that "doctor-patient relationships between the investigator and participants should be avoided, when possible, to eliminate any power-based coercion."

It's impossible to know whether Markingson would have killed himself if he hadn't enrolled in the research study. He was in a sensitive early stage of his schizophrenia diagnosis, during which the suicide risk is greatest. Even so, the study's rigid guidelines meant that Markingson received only one anti-psychotic drug to help control his delusions.

Experts hired by Weiss' attorneys said in court depositions that the IRB missed opportunities to make the study safer.

Dr. Harrison Pope from Harvard Medical School called the IRB's role an "essential link in the chain of causation that improperly admitted Mr. Markingson into the CAFE study, improperly held Mr. Markingson within the CAFE study, prohibited effective treatment of Mr. Markingson, and thus became a substantial, proximate cause of Mr. Markingson's death."

The IRB could insist researchers turn over all complaints about their studies, which might have raised concerns in this case. Weiss had complained in letters to Olson and Dr. Charles Schulz, head of the U's Department of Psychiatry, that her son wasn't getting better and was at risk for harm. She had requested that the doctors try other treatments, even if he had to be withdrawn from the study.

The U hired its own national IRB expert to refute Pope's claims. The IRB had no legal obligation to require someone other than Olson to evaluate Markingson's competency or his ability to consent to research, said Ernest Prentice, associate vice chancellor at the University of Nebraska Medical Center.

Nor is there a requirement that complaints such as Weiss' letters be forwarded to the IRB unless there is some unanticipated risk. Had the IRB received complaints, it could have investigated, he said.

Weiss said she'd never heard of an IRB.

The CAFE study was fairly prominent, involving 26 academic institutions and 400 schizophrenic patients. Financed by the pharmaceutical company AstraZeneca, it was worth up to $327,000 to the U, with some of those funds going to Olson's salary and other study personnel.

U officials said the IRB acted ethically and within its obligations and federal regulations to protect human subjects in this study.

After the suicide, the IRB sought information from Olson on how Markingson consented to the study. But IRB officials said in depositions for the lawsuit that the review board never formally investigated Markingson's death.

The IRB investigates when there is evidence of misconduct. There was no evidence of that in the Markingson case, said Dr. Richard Bianco, a U physician who oversaw the U's research subjects program at the time Markingson participated in the study.

Bianco declined a Pioneer Press interview request. But in a court deposition, he acknowledged that the U has some 8,000 studies involving humans — research he estimated was worth about $15 million — but that the IRB doesn't track the number of people enrolled in U research, only the number of projects approved.

Bianco agreed with Keane that the IRB system operates largely on self-disclosure by researchers.

The U's top research official says researchers and IRB reviewers "are aware and understand their ethical and moral obligations to do the right thing.

"If people write with concerns and issues, they will be reviewed," said Tim Mulcahy, the U's vice president of research. "If the IRB were to become aware of a suggestion of coercion or heavy handedness," he added, "we have an obligation to act promptly and very directly."

Olson declined to talk to the Pioneer Press about Markingson's care.

He said it would be difficult for any researcher to get away with violating research rules because they are observed by so many medical students, residents, nurses and others. However, a 2006 internal audit of the U's psychiatry department challenges the notion that those workers would speak up.

Nearly 40 percent of the psychiatry department staff responding to the auditor survey said they did not believe they would be protected from retaliation for blowing the whistle on a suspected violation in the department.

Some experts believe the nation's system of review boards is dysfunctional and in need of reform.

"We have a very haphazard way of overseeing (IRBs) and collecting data on adverse events," said Dr. Ezekiel Emanuel, bioethics chair at the Clinical Center of the National Institutes of Health and a national expert on institutional review boards.

"There's no one in America who can tell you how many people are enrolled in clinical research," he said. "No one can tell you how many people died in (ways) attributable to clinical research. No one can tell you how many people got injured, and no one can tell you over time whether the system is getting less safe."

Many Popular Drugs Linked to Suicide

From News Inferno.com

Suicide is common in the US, representing the fourth leading cause of death for those aged 18 to 65 and the third leading cause for those aged 15 to 24. Add to those figures the complexity of medications. In recent years, disturbing reports have suggested that side effects of some popular drugs - such as Chantix, Accutane, Singular and Paxil - include suicidal thoughts and behavior.

Reports have been filed with drug makers and the Food and Drug Administration (FDA) on at least six drugs or drug classes that may be linked to suicide or suicidal thoughts. Recently, the FDA released notices about several such medications including Singlulair; Epilepsy drugs including carbamazepine, gabapentin, felbamate, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, and valproate; and the smoking-cessation drug Chantix. Reports have been filed on SSRI antidepressants including Paxil and Prozac, the influenza drug Tamiflu, and the acne medicine Accutane. “The brain is a complex organ, and most of the drugs are complex as well,’’ says Dr. Thomas Laughren, head of the division of psychiatric products at the FDA. “It’s not unreasonable to think that a drug that gets into the brain may have effects other than you hope they would.’’

Kelly Posner, principal investigator at the Center for Suicide Risk Assessment at Columbia University in New York, is working with the FDA to determine suicide risks and at-risk categories; Posner’s quantitative tools and questionnaires are being applied to drugs on the market and in testing. “We know that whether or not these drugs actually cause suicidal thought or action is a question we have to answer, but up until now, none of the clinical trials for the drugs were set up to address the question,’’ says Posner.

There are theories, says Jason Noel, director of clinical pharmacy services at Rosewood Center in Owings Mills, Maryland. Asthma medication Singulair has a similar chemical pathway to steroids, which can affect behavior and mood and an asthma diagnosis can trigger suicide or depression because it adversely affects daily living. Fatigue is a symptom of depression, the initial benefit of antidepressants is increased energy, and improving depression can take weeks; therefore, some may use extra energy to act on suicidal thoughts. Suicidal thoughts in patients taking epilepsy drugs have been reported in patients on such medications for epilepsy, depression, or other psychiatric conditions; however, not generally in those on the drugs for migraines. Chantix blocks pleasure pathways that make nicotine so satisfying, which suppresses other pleasure and happiness, leading to depression. But, stopping smoking can be a risk factor for depression and smoking is a risk factor for suicide.

Finding links has risks. When the FDA discovered an increase in suicidal thinking in children and young adults taking antidepressants, warnings were added to Paxil and Prozac labeling. “Use of antidepressants went down and the suicide rate went up,’’ says Dr. Paula Clayton, medical director of the American Foundation for Suicide Prevention in New York.

Meanwhile, Congressman Bart Stupak (Democrat-Michigan) reported his teenage son B.J. killed himself in 1999 after several months on Accutane and said in 1998, the FDA publicly noted reports of depression, psychosis, and suicidal thoughts and actions with Accutane; in 1999 when B.J. was prescribed Accutane, their doctor did not inform them of the risk and the prescription’s patient information did not include it.

VA faulted in diagnosing suicide candidates, Senators want VA's mental health chief to resign

There are plenty reports on this to choose from. Here's one from the Seattle Post Intelligencer

Sen. Patty Murray, D-Wash., on Tuesday called for the chief mental health official of the U.S. Department of Veterans Affairs to resign, saying he tried to cover up the rising number of veteran suicides.

Murray, the senior member of the Senate Veterans Affairs Committee, said Dr. Ira Katz, the VA's mental health director, deliberately withheld crucial information on the true suicide risk among veterans.

"Dr. Katz's irresponsible actions have been a disservice to our veterans and it is time for him to go," Murray said. "The number one priority of the VA should be caring for our veterans, not covering up the truth."

Murray and other Democratic senators said they were appalled at e-mails showing that Katz and other VA officials tried to conceal the number of suicides by veterans. An e-mail message from Katz revealed at a lawsuit this week starts with "Shh!" and refers to the 12,000 veterans per year who attempt suicide while under department treatment.

"Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" the e-mail asks.

A lawyer for a veterans group showed the e-mail as part of a lawsuit being heard in San Francisco that alleges the VA failed to properly treat thousands of veterans for mental illness.

An e-mail revealed at the trial said an average of 18 military veterans kill themselves each day - and five of them are under VA care when they commit suicide.

"It is completely outrageous that the federal agency charged with helping veterans would instead cover up the hard truth - that more and more Americans coming home after bravely fighting for their country are suffering from mental illnesses and in the most tragic circumstances, committing suicide," said Sen. Tom Harkin, D-Iowa. "Anyone at the VA who is involved in this cover-up should be removed immediately."

Harkin, Murray and Sen. Russ Feingold, D-Wis., introduced legislation Tuesday calling on the VA to track how many veterans die by suicide each year. Currently, VA facilities record the numbers of suicide deaths and attempts in VA facilities - which have increased from 492 in 2000 to 790 in 2007 - but do not record how many veterans overall take their own lives.

The new bill would require the VA to report to Congress within 180 days the number of veterans who have died by suicide since Jan. 1, 1997, and continue reports annually.

"We are looking at a real crisis among our veterans and it is high time the VA recognizes it," said Harkin. "Tracking the number of suicides among our veterans will help us to better understand the true depths of this crisis, so we may ensure we are doing everything we can to address their mental health needs."

A spokesman for the VA declined immediate comment Tuesday.

A government lawyer on Monday urged a judge to dismiss a class-action lawsuit against the VA, saying the agency runs a "world class" medical care system.

Two veterans groups filed suit against a sprawling VA system that handled a record 838,000 claims last year. A federal judge in San Francisco is hearing the case in a two-week, non-jury trial.