Psychiatrist Arrested for Drugs Falsified Records

From the Ashley County Ledger in Arizona

Ashley County Quorum Court members received an update of the circumstances that led to the hiring, termination and arrest of a former Ashley County Medical Center psychiatrist employed two weeks at the facility's Generations unit.

Hospital Administrator Russ Sword terminated Paul Jay Loop, 46, Monday, December 3, after Sword learned of Loop's drug abuse.

According to the ACMC hospital report presented to the court during its December meeting, Loop was terminated and his privileges to practice medicine at ACMC were revoked. The Crossett Police Department was informed of the situation, and officers arrested Loop on possession of crack cocaine in Sword's office. At the time of his arrest, six rocks of crack cocaine were found in Loop's possession. In addition to the cocaine, law enforcement officers found drug paraphernalia during a search conducted by the Crossett Police Department and the Ashley County Sheriff's Department of his hotel room at the Levee Inn.

"ACMC responded to the situation promptly and decisively and reported the matter to the Arkansas Medical Board," Sword said in its report presented to the court.

"All Arkansas hospitals, including Ashley County Medical Center, are required by state regulations to use the centralized credentialing services of the Arkansas Medical Board when reviewing physicians who are applying for hospital privileges. "

It further notes that during the medical board's review process, applicants' background, medical school, residency programs, as well as previous practices and other state medical board's recommendations are checked. "ACMC receives a written report from the Arkansas Medical Board before acting on a physician's request for clinical privileges," he added.

Although ACMC received a favorable report on Loop from the medical board, it is now known that Loop falsified his application to ACMC as well as information he submitted to the Arkansas Medical Board, according to the report.

The Arkansas Medical Board has suspended Loop’s license pending a hearing in February in regard to revoking his license.

The Diagnosis and Treatment of Childhood

Having noticed web traffic looking for this article, we are providing for the benefit of readers a full copy of the satire with the title “The Diagnosis and Treatment of Childhood”, which also fits well with the satire "Babies: 100% suffer from Depression" cited earlier on this site. Note that the actual title this satire is not “The Diagnosis and Treatment of Childhood”, but is rather is “The Etiology and Treatment of Childhood”. It still works.

---

The Etiology and Treatment of Childhood
by Jordan W. Smoller

University of Pennsylvania
http://users.erols.com/geary/humor/

Childhood is a syndrome which has only recently begun to receive serious attention from clinicians. The syndrome itself, however, is not at all recent. As early as the 8th century, the Persian historian Kidnom made references to "short, noisy creatures," who may well have been what we now call "children." The treatment of children, however, was unknown until this century, when so-called "child psychologists" and "child psychiatrists" became common. Despite this history of clinical neglect, it has been estimated that well over half of all Americans alive today have experienced childhood directly (Suess, 1983). In fact, the actual numbers are probably much higher, since these data are based on self-reports which may be subject to social desirability biases and retrospective distortion.

The growing acceptance of childhood as a distinct phenomenon is reflected in the proposed inclusion of the syndrome in the upcoming Diagnostic and Statistical Manual of Mental Disorders, 4th edition, or DSM-IV, of the American Psychiatric Association (1990). Clinicians are still in disagreement about the significan clinical features of childhood, but the proposed DSM-IV will almost certainly include the following core features:

Congenital onset

Dwarfism

Emotional lability and immaturity

Knowledgy deficits

Legume anorexia

Clinical Features of Childhood

Although the focus of this paper is on the efficacy of conventional treatment of childhood, the five clinical markers mentioned above merit further discussion for those unfamiliar with this patient population.

CONGENITAL ONSET

In one of the few existing literature reviews on childhood, Temple-Black (1982) has noted that childhood is almost always present at birth, although it may go undetected for years or even remain subclinical indefinitely. This observation has led some investigators to speculate on biological contribution to childhood. As one psychologist has put it, "we may soon be in a position to distinguish organic childhood from functional childhood" (Rogers, 1979).

DWARFISM

This is certainly the most familiar marker of childhood. It is widely known that children are physically short relative to the population at large. Indeed, common clinical wisdom suggests that the treatment of the so-called "small child" (or "tot") is particularly difficult. These children are known to exhibit infantile behavior and display a startling lack of insight (Tom and Jerry, 1967).

EMOTIONAL LABILITY AND IMMATURITY

This aspect of childhood is often the only basis for a clinician's diagnosis. As a result, many otherwise normal adults are misdiagnosed as children and must suffer the unnecessary social stigma of being labelled a "child" by professionals and friends alike.

KNOWLEDGE DEFICITS

While many children have IQs with or even above the norm, almost all will manifest knowledge deficits. Anyone who has known a real child has experienced the frustration of trying to discuss any topic that requires some general knowledge. Children seem to have little knowledge about the world they live in. Politics, art, and science--children are largely ignorant of these. Perhaps it is because of this ignorance, but the sad fact that most children have few friends who are not, themselves, children.

LEGUME ANOREXIA

This last identifying feature is perhaps the most unexpected. Folk wisdom is supported by empirical observation--children will rarely eat their vegetables (see Popeye, 1957, for review).

Causes of Childhood

Now that we know what it is, what can we say about the causes of childhood? Recent years have seen a flurry of theory and speculation from a number of perspectives. Some of the most prominent are reviewed below.

Sociological Model

Emile Durkind was perhaps the first to speculate about sociological causes of childhood. He points out two key observations about children:

the vast majority of children are unemployed, and

children represent one of the least educated segments of our society. In fact, it has been estimated that less than 20% of children have had more than fourth grad education.

Clearly, children are an "out-group." Because of their intellectual handicap, children are even denied the right to vote. From the sociologist's perspective, treatment should be aimed at helping assimilate children into mainstream society. Unfortunately, some victims are so incapacitated by their childhood that they are simply not competent to work. One promising rehabilitaion program (Spanky and Alfalfa, 1978) has trained victims of severe childhood to sell lemonade.

Biological Model

The observation that childhood is usually present from birth has led some to speculate on a biological contribution. An early investigation by Flintstone and Jetson (1939) indicated that childhood runs in families. Their survey of over 8,000 American families revealed that over half contained more than one child. Further investigation revealed that even most non-child family members had experienced childhood at some point. Cross-cultural studies (e.g., Mowgli and Din, 1950) indicated that family childhood is even more prevalent in the Far East. For example, in Indian and Chinese families, as many as three out of four family members may have childhood.

Impressive evidence of a genetic component of childhood comes from a large-scale twin study by Brady and Partridge (1972). These authors studied over 106 pairs of twins, looking at concordance rates for childhood. Among identical or monozygotic twins, concordance was unusually high (0.92), i.e., when one twin was diagnosed with childhood, the other twin was almost always a child as well.
Psychological Models

A considerable number of psychologically-based theories of the development of childhood exist. They are too numerous to review here. Among the more familiar models are Seligman's "learned childishness" model. According to this model, individuals who are treated like children eventually give up and become children. As a counterpoint to such theories, some experts have claimed that childhood does not really exist. Szasz (1980) has called "childhood" an expedient label. In seeking conformity, we handicap those whom we find unruly or too short to deal with by labelling them "children."

Treatment of Childhood

Efforts to treat childhood are as old as the syndrome itself. Only in modern times, however, have human and systematic treatment protocols been applied. In part, this increased attention to the problem may be due to the sheer number of individuals suffering from childhood. Government statistics (DHHS) reveal that there are more children alive today than at any time in our history. to paraphrase P.T. Barnum: "There's a child born every minute."

The overwhelming number of children has made government intervention inevitable. The nineteenth century saw the institution of what remains the largest single program for the treatment of childhood-- so-called "public schools." Under this colossal program, individuals are placed into treatment groups based on the severity of their condition. For example, those most severely afflicted may be placed in a "kindergarten" program. Patients at this level are typically short, unruly, emotionally immature, and intellectually deficient. Given this type of individual, therapy is essentially one of patient management and of helping the child master basic skills (e.g. finger-painting).

Unfortunately, the "school" system has been largely ineffective. Not only is the problem a massive tax burden, but it has failed even to slow down the rising incidence of childhood.

Faced with this failure and the growing epidemic of childhood, mental health professionals are devoting increasing attention to the treatment of childhood. Given a theoretical framework by Freud's landmark treatises on childhood, child psychiatrists and psychologists claimed great successes in their clinical intervention.

By the 1950's, however, the clinicians' optimism had waned. Even after years of costly analysis, many victims remained children. The following case (taken from Gumbie and Poke, 1957) is typical.

Billy J., age 8, was brought to treatment by his parents. Billy's affliction was painfully obvious. He stood only 4'3" high and weighed a scant 70 lbs., despite the fact that he ate voraciously. Billy presented a variety of troubling symptoms. His voice was noticably high for a man. He displayed legume anorexia, and, according to his parents, often refused to bathe. His intellectual functioning was also below normal--he had little general knowledge and could barely write a structured sentence. Social skills were also deficient. He often spoke inappropriately and exhibited "whining behaviour." His sexual experience was non-existent. Indeed, Billy considered women "icky." His parents reported that his condition had been present from birth, improving gradually after he was placed in a school at age 5. The diagnosis was "primary childhood." After years of painstaking treatment, Billy improved gradually. At age 11, his height and weight have increased, his social skills are broader, and he is now functional enough to hold down a "paper route."

After years of this kind of frustration, startling new evidence has come to light which suggests that the prognosis in cases of childhood may not be all gloom. A critical review by Fudd (1972) noted that studies of the childhood syndrome tend to lack careful follow-up. Acting on this observation, Moe, Larrie, and Kirly (1974) began a large-scale longitudinal study. These investigators studied two groups. The first group consisted of 34 children currently engaged in a long-term conventional treatment program. The second was a group of 42 children receiving no treatment. All subjects had been diagnosed as children at least 4 years previously, with a mean duration of childhood at 6.4 years.

At the end of one year, the results confirmed the clinical wisdom that childhood is a refractory disorder--virtually all symptoms persisted and the treatment group was only slightly better off than the controls.

The results, however, of a careful 10-year follow-up were startling. The investigators (Moe, Larrie, Kirly, & Shemp, 1984) assessed the original cohort on a variety of measures. General knowledge and emotional maturity were assessed with standard measures. Height was assess by the "metric system" (see Ruler, 1923), and legume appetite by the Vegetable Appetite Test (VAT) designed by Popeye (1968). Moe et al. found that subjects improved uniformly on all measures. Indeed, in most cases, the subjects appeared to be symptom-free. Moe et al. report a spontaneous remission rate of 95%, a finding which is certain to revolutionize the clinical approach to childhood.

These recent results suggests that the prognosis for victims of childhood may not be so bad as we have feared. We must not, however, become too complacent. Despite its apparently high spontaneous remission rate, childhood remains one of the most serious and rapidly growing disorders facing mental health professionals today. And, beyond the psychological pain it brings, childhood has recently been linked to a number of physical disorders. Twenty years ago, Howdi, Doodi, and Beauzeau (1965) demonstrated a six-fold increased risk of chicken pox, measles, and mumps among children as compared with normal controls. Later, Barby and Kenn (1971) linked childhood to an elevated risk of accidents--compared with normal adults, victims of childhood were much more likely to scrape their knees, lose their teeth, and fall off their bikes.

Clearly, much more research is need before we can give any real hope to the millions of victims wracked by this insidious disorder.

REFERENCES

American Psychiatric Association (1990). The diagnostic and statistical manual of mental disorders, 4th edition: A preliminary report. Washington, D.C.; APA.

Barby, B., & Kenn, K. (1971). The plasticity of behavior. In B. Barby & K. Kenn (Eds.), Psychotherapies R Us. Detroit: Ronco press.

Flintstone, F., & Jetson, G. (1939). Cognitive mediation of labour disputes. Industrial Psychology Today, 2, 23-35.

Fudd, E.J. (1972). Locus of control and shoe-size. Journal of Footwear Psychology, 78, 345-356.

Gumbie, G., & Pokey, P. (1957). A cognitive theory of iron- smelting. Journal of Abnormal Metallurgy, 45, 235-239.

Howdi, C., Doodi, C., & Beauzeau, C. (1965). Western civilization: A review of the literature. Reader's digest, 60, 23-25.

Moe, R., Larrie, T., and Kirly, Q. (1974). State childhood versus trait childhood. TV Guide, May 12-19, 1-3.

Moe, R., Larrie, T., Kirly, Q. (1974). Spontaneous remission of childhood. In W.C. Fields (Ed.), New Hope for Children and Animals. Hollywood: Acme Press.

Popeye, T.S.M. (1957). The use of spinach in extreme circumstances. Journal of Vegetable Science, 58, 530-538.

Popeye, T.S.M. (1968). Spinach: A phenomenological perspective. Existential botany, 35, 908-813.

Rogers, F. (1979). Becoming my neighbour. New York: Soft Press.

Ruler, Y. (1923). Assessing measurements protocols by the multi-method multiple regression index for the psychometric analysis of factorial interaction. Annals of Boredom, 67, 1190-1260.

Spanky, D., & Alfalfa, Q. (1978). Coping with puberty. Sears catalog, 45-46.

Suess, D.R. (1983). A psychometric analysis of green eggs with and without ham. Journal of Clinical Cuisine, 245, 567-578.

Temple-Black, S. (1982). Childhood: an ever-so sad disorder. Journal of Precocity, 3, 129-134.

Tom, C., & Jerry, M. (1967). Human behavior as a model for understanding the rat. In M. de Sade (Ed.). The Rewards of Punishment. Paris: Bench Press.

Rotenberg Center treats two students with dozens of shocks based on prank telephone call.

As reported in the Boston Globe. Note that they say that no damage was done.

I think that they conveniently overlook any mental damage caused by electric shocks, never mind the injustice of having it administered due to prank telephone calls. In fact, they call this damage therapeutic. Obviously, Rotenberg should be pronounced ROTTEN-berg.

Two special education students at the controversial Judge Rotenberg Educational Center in Canton were wrongfully delivered dozens of punishing electrical shocks in August based on a prank phone call from a former student posing as a supervisor, a state investigative report has found.

School staffers contacted state authorities after they realized they had been tricked on Aug. 26 into delivering 77 shocks to one student and 29 shocks to another, according to Cindy Campbell, a spokeswoman for the Department of Early Education and Care, which drafted the report. Both students were part of a Rotenberg-run group home in Stoughton for males under age 22.

The Judge Rotenberg center, which serves about 250 adults and children from across the country, has been under fire for more than two decades for its unorthodox behavior-modification treatments, including electric shock treatments. Its defenders say that the school takes in troubled students, some with self-damaging behavior, who have been rejected by other schools. The center, which Massachusetts officials have tried twice to close because of its treatment methods, focuses on serving people with autism, mental retardation, and emotional problems.

Ernest Corrigan, a spokesman for the Rotenberg center, said the school contacted law enforcement "within hours" after discovering the prank, and that such an incident has never before happened at the school. Corrigan said they have instituted new safeguards to prevent such occurrences. He also said that while the school regrets the incident, the two male students who received the wrongful shocks did not experience any serious physical harm and did not need medical treatment afterwards.

The shock devices, which are strapped to some students' arms, legs, or torsos, deliver two-second electric jolts to the skin. The devices are controlled remotely by teachers.

State officials said the identity of the prankster is known to law enforcement authorities, but they would not release his name publicly and he has not been arrested. The identity of the staffer who was fooled into administering the shocks has also not been released. State officials indicated that some disciplinary action took place, though they would not specify what it was.

According to records from the Disabled Persons Protections Commission hotline phone log, there are repeated complaints about the incident. One entry said "the caller claimed that the shocks were approved, however, they were not."

Based on the prankster's call, one of the students was also wrongfully placed in four-point restraints, limiting mobility of all four limbs.

Critics of the Rotenberg school say the case shows that school officials have failed to live up to their public promises to deliver electric shocks only sparingly and with great oversight.

"This shows a systemic breakdown at the center," said Leo Sarkissian, executive director of ARC of Massachusetts, which represents people with cognitive and developmental disabilities. "It only takes a phone call to instigate shocks to this degree."

Top officials in New York and Washington, D.C., where many of the center's students originate, have called for a stop to the controversial shock treatments at the school.

Yesterday, in a prepared statement, state Senator Brian Joyce called on officials to more strictly limit and regulate the use of shock therapy in the state.

"This incident is horrifying and it would be immoral for the Legislature and the Executive branch not to react strongly and swiftly," Joyce said.

Corrigan, the spokesman for the center, said he is confident the August case will not be repeated, and he hopes this episode "will not be used to overshadow the good work that we do for those who have no where else to go."

Washington DC Mayor to Pull Children From Rotenberg Center.

A seen in this report, at least some politicians are doing the right thing, and getting the children out of this horrible place.

Mayor Adrian Fenty’s administration will get nine local children out of a Massachusetts shock-therapy clinic “within 90 days,” the mayor’s top adviser told The Examiner.

“It is unacceptable. Absolutely unacceptable to have our kids at that school,” said Peter Nickles, Fenty’s legal adviser, referring to the Judge Rotenberg Center. “We are taking steps right now so that within 90 days, those kids will be out of the Rotenberg school.”

As reported by The Examiner, dozens of mentally disabled children from the District of Columbia have been farmed out to Rotenberg for more than a decade, costing the public millions of dollars.

The center specializes in “aversive therapy” such as electroshock backpacks and has been the subject of dozens of abuse complaints to Massachusetts authorities for more than a decade.

The Examiner reported last week that Massachusetts officials have opened a criminal investigation after a Rotenberg student made a prank phone call and ordered three of his fellows hooked up to electric-shock machines.

Two of the students were shocked at least 77 times, state documents show.

E-mails obtained by The Examiner show that D.C. officials continued to refer students to Rotenberg even after Schools Chancellor Michelle Rhee ordered the clinic stricken from the approved vendors list. Despite evidence that city officials were behind the blunder, Nickles blamed the children’s parents and their lawyers for standing in the way of getting the kids out of Rotenberg.

“We’re going to talk to parents,” Nickles said. “We’re in the process of finding alternative placements and we’re going to get this done.”

Documents obtained by The Examiner show that school officials have tried but failed to find alternate schools for the students at Rotenberg. Part of the problem is that at least four of the students are at least 18 years old and few other schools will take in adults, internal e-mails show.

Rotenberg spokesman Ernest Corrigan didn’t respond to requests for comment.

News of Nickles’ promise was welcomed by District Council Member Mary Cheh, D-Ward 3, an outspoken critic of Rotenberg — and the D.C. bureaucrats who consigned the city’s children there.

“All I can say is, the sooner, the better,” Cheh told The Examiner. “It should have been done before now.”

Another psychiatrist sex scandal

A report from Cleveland County, North Carolina.

A Shelby psychiatrist, accused of having an inappropriate relationship with a patient, signed a consent order indefinitely suspending her medical license.

Dr. Kerry L. Balentine was accused of having a romantic relationship with one of her patients after that patient’s wife died in September 2006. Balentine began grief counseling the patient, the consent order said. She had previously treated him for about a year.

According to documents from the North Carolina Medical Board, Balentine began the relationship after accepting an invitation for coffee.

The order said Balentine stopped seeing the patient in her office in October 2006, “implying that he was discharged from her care but not clearly terminating their physician-patient relationship.”

It also stated that Balentine provided prescriptions for medications, including controlled substances to the patient, after the relationship began and did not chart them.

“Dr. Balentine admits that her relationship with (the patient) violated boundaries as well as the ethics of the psychiatric profession and the medical profession as a whole,” the document said.

According to the consent order, dated Dec. 14, Balentine’s license is indefinitely suspended, she agrees to obey all laws, rules and regulations involving medical practice, she is required to notify the board of any change in residence or practice and that she will meet with the board as requested.

If she fails to comply with the order, the board will have grounds to annul, suspend or revoke her medical license.

She had medical privileges at Cleveland Regional Medical Center and Kings Mountain Hospital.

Psychiatrist Billed Medicaid For Patients Never Treated

As seen in this report, psychiatrists and other mental health specialist have been caught having a field day billing the state of New York for everything they could get away with. Fortunately, they have been caught by auditors from the State of New York's comptroller's office. Click here for a copy of the audit.

A psychiatrist improperly billed Medicaid on eight separate occasions for more than 24 hours of treatment in a single day and appears to have billed for patients he never treated, among other improper practices, according to an audit released today by the state comptroller’s office.

“Most doctors work hard, but it is difficult to imagine how anyone can put in more than 24 hours in one day on multiple occasions,” comptroller Thomas DiNapoli said. “This should have immediately raised red flags and the psychiatrist should never have been paid. Better systems must be put in place by the Department of Health to prevent these types of payments from being made in the first place.”

In an analysis of payments for mental health services from August 1999 to October 2006, auditors identified more than $1.3 million in Medicaid overpayments for mental health services – many of which could have been prevented with additional controls in the eMedNY Medicaid claims processing system. The State Department of Health (DOH) administers Medicaid and the eMedNY system.

Among the audit’s primary findings:

One mental health provider who was paid more than $436,000 billed Medicaid on eight separate occasions for more than 24 hours — and as high as 42 hours in one instance — of service in a single day.

He admitted to auditors he did not see certain patients for which he billed Medicaid. Auditors also discovered his clinical social worker saw certain patients but Medicaid was billed at the higher psychiatrist’s rate.

Some 389 providers submitted more than 27,000 claims valued at $662,000 for mental health services and pharmacologic management provided on the same day. Under Medicaid rules, psychiatrists who provide mental health evaluation and management services for patients cannot bill the program for prescribing medication — known as pharmacologic management — on the same day.

–106 clinic-based mental health practitioners received 21,132 payments totaling more than $381,000 from June 2002 through December 2005 for services for which the clinic also received payment. When services are provided at clinics, only the clinic not the individual service provider is permitted to bill Medicaid.

–1,898 instances were identified in which 27 different clinics had billed Medicaid twice at different rates for the same services. From June 2001 through October 2006, the overpayments totaled $302,568.

Auditors met with nine of these providers who double billed, eight of whom indicated that they were confused about the rules and misinterpreted DOH policy. The auditors recommended that DOH add a control to the eMedNY system to block payment for pharmacologic management when it is billed in conjunction with other mental health services. Auditors made a similar recommendation to improve the eMedNY system to block duplicate payments.

DOH indicated in its response to the audit that it would implement recommended controls and other strategies to avoid many of the overpayments found by auditors and would seek to recover any funds paid to providers in error. The complete response is included in the audit.

The findings of the audit have been referred to the Office of the Attorney General.

The Office of the State Comptroller conducts regular audits of the state’s $47 billion Medicaid program, identifying hundreds of millions of overpayments and fraud. Auditors review Medicaid claims that have been submitted by service providers and identify billing patterns and other circumstances that warrant an examination to determine whether claims are valid and appropriate. In 2007 alone, the State Comptroller’s Office identified more than $43 million in potential overpayments or inappropriate claims paid by the state’s Medicaid program.

Psychiatric drugs in the life of the Nebraska mall sniper Robert Hawkins

From an interview on ABC News Good Morning Program:

Rodriguez said her son's life had been a challenge from the start. She divorced Hawkins' father when the boy was 3-years-old, she said, and by 5 he was taking prescription Ritalin and Zoloft. She said she watched, feeling helpless the way a parent can, as raw anger took root inside her son.

First there were fights at school, she said. Then he was caught smoking cigarettes. Then marijuana.

He became a ward of the state in 2002 after apparently threatening his stepmother. He was moved through facilities and foster homes for several years, until he was released in 2005. Two weeks before the shooting rampage, Hawkins parted ways with his girlfriend.

Rodriguez said she sympathizes deeply with the families of her son's victims.

There is no reason to suppose that these deadly drugs did not continue while Hawkins was in state custody. Or that the known side effects of these drugs did not have a deadly impact.

Anna Nicole Smith's Son Daniel Killed by Deadly Cocktail of Psychiatric Drugs.

From this ABC News Report. For more information see also our earlier reports on the psychiatrist of Anna Nicole Smith, Dr. Khristine Eroshevich, who is currently being investigated by authorities for a number of suspicious matters in connection with the death of Anna Nicole Smith.

Testimony this week on the death of Daniel Smith, the 20-year-old son of late Playboy playmate Anna Nicole Smith, suggests that he met his demise in much the same way as his mother — a toxic mix of prescription drugs.

Bahamian doctor Govinda Raju — who performed the official autopsy on Daniel Smith's body after he died Sept. 10, 2006 — testified Monday that a combination of three drugs found in the man's system were the likely cause of death, according to Associated Press reports.

[...] Cyril Wecht, the forensic pathologist hired by the Smith family to perform a second autopsy, says there is little doubt that Daniel Smith's death was due to a combination of three drugs, rather than methadone.

"He had died as a result of three drugs — methadone, along with the antidepressants Lexapro and Zoloft," he said. "I would say that they were all at high therapeutic levels, and none on its own was at a lethal level."

"The three of these together can result in death, unquestionably. It is a classical situation that we see so often known as acute combined drug toxicity."

[...]

Wecht says that the addition of the two antidepressants would have led to a profound sedation — one that would only worsen in the next few hours in which the drugs would take full effect.

"Together, it's a central nervous system depressant," Wecht said. "All three of these drugs act to depress the brain, and by doing so indirectly result in the depression of cardiac and respiratory function."

In the initial stages of drug poisoning, Wecht says, Daniel Smith would first have become somewhat drowsy. This symptom would likely have progressed into a state of stupor, followed by unconsciousness.

The final steps in this deadly cascade are respiratory arrest, cardiac arrest and finally cardiac standstill.

Bipolar toddlers? Maybe discipline is the answer

A book review seen here, and on the author's website here. From a book review on The Bipolar Child (Broadway, $27.95), by Dr. Dimitri Papolos and his wife Janice. Here is a fair use snippet:

[...]

Seemingly, the Papoloses would have us believe that behaviors normally associated with toddlerhood are actually manifestations of a disease that should be treated with drugs that have pronounced negative side effects (e.g., nausea, diarrhea, severe drowsiness, significant weight gain) as soon in the child's life as possible. Are the "terrible 2s" a disease?

Should most toddlers be on drugs? I have to admit to having no small amount of difficulty with the reasoning involved here. One thing is certain: The Papoloses are a boon to both the mental health and pharmaceutical industries. I'm not so certain they are a boon to children.

In their book and in the May 2007 issue of their newsletter, available through their Web site, the Papoloses recommend against using the word "no" with a bipolar child "because it will trigger a meltdown." When they were toddlers, my children often suffered wild seizures at the sound of "no."

Interestingly, however, these seizures were eventually cured with regular doses of that very word in combination with consequences the Papoloses would probably consider draconian. My wife and I were unaware that we should have been giving them drugs.

In the same issue of their newsletter, the Papoloses say that parents of bipolar children should "suffer the physical abuse" of their children. Over the past few years, I've consulted with quite a few parents of children ages 2 and older who were prone to hitting and kicking their parents when their parents did not give them their way. In nearly every case (I actually know of no exceptions), these kids were cured of their criminal tendencies in short order by parents who did not suffer this abuse, parents who administered not drugs but quite old-fashioned discipline.

[...]

Cited in the column is a satire with the title “The Diagnosis and Treatment of Childhood”, which also fits well with the satire "Babies: 100% suffer from Depression" cited earlier on this site

Artem Basyrov, A Case Of Punitive/Political Psychiatry?

from the Daily Mail:

A Russian opposition activist has been sent to a psychiatric hospital by authorities a day before a planned demonstration.

Artem Basyrov's detention is the latest in a series of incidents suggesting a punitive Soviet-era practice is being revived under president Vladimir Putin.

Mr Basyrov, 20, was ordered to be held at a hospital in the central region of Mari El on November 23, a day before planned demonstrations, said Alexander Averin of the opposition National Bolshevik Party.

The party is part of the Other Russia coalition which organised the so-called Dissenters' Marches across the country this year.

Mr Basyrov ran for the local legislature as an Other Russia candidate.

Police who originally detained him claimed he had assaulted a girl.

A local psychiatric board agreed, deciding the activist suffered from a mental illness and he was committed to the psychiatric hospital three weeks ago.

He was only transferred from an isolation ward and allowed to have visitors on Thursday, said Mikhail Klyuzhev, a National Bolshevik member from the city of Yoshkar-Ola.

The allegations against Mr Basyrov were "idiocy" and were "part of the hysteria" before Russia's parliamentary elections which were held on December 2, Mr Klyuzhev added.

Supporters said Mr Basyrov did not appear to have been mistreated.

A psychiatric board is due to review his case at the end of the month.

His case is the latest example of journalists or opposition activists being involuntarily committed to psychiatric hospitals in Russia.

During the Soviet era, dissidents were frequently committed for protesting against Soviet policies.

Last week, Reporters Without Borders said Andrei Novikov, a reporter for a news service connected with Chechen separatist government, was released after nine months in a psychiatric hospital.

Earlier this year Larisa Arap, an Other Russia activist and journalist, spent six weeks in a psychiatric clinic.

Supporters said this was punishment for her critical reporting.

The Global Initiative on Psychiatry, a Dutch watchdog, says psychiatry continues to be used for punitive, political purposes in Russia.

Prosecutors in Mari El were not available for comment last night.

Ads About Kids’ Mental Health Problems Draw Fire

The WSJ Health Blog points to a current controversy over an advertisement looking at the need for mental health services for children.

It seems that somebody in NY did something rather offensive:

New York University’s Child Study Center wanted a provocative new campaign to raise awareness about childhood mental health disorders. Well, it got one, and now NYU’s learning that there’s a fine line between attention-grabbing and offensive.

The center’s new ad campaign, which began last week, uses images of ransom notes to drive home the message that 12 million children are being held hostage by mental health problems, such as depression and autism.

But almost immediately, the Autistic Self Advocacy Network, an advocacy group for people with autism-spectrum disorders, took offense to the ads, calling them stigmatizing and inaccurate. The autism note, for instance, implies that children with autism have no social skills and are doomed to social isolation, Ari Ne’eman, ASAN president, tels the Health Blog. “It’s not only not true, it’s a slap in the face to many people with disability,” he says.

On Tuesday, the group sent the NYU center and the campaign’s ad agency, BBDO New York, a letter of complaint signed by 13 local and national advocacy organizations. More groups came forward yesterday to join in the effort after hearing about it, Ne’eman said.

[...]

NYU has no plans to stop the campaign.

This kind of fear mongering to promote the use of psychiatric services is offensive in the extreme. One can imagine the outrage if a similar ad was run for a political campaign or some commercial product, like an automobile.

There are no cures in modern Psychiatry. They wouldn't know a cure if it stood up and slapped them in the face.

While we are pointing to posts from Furious Seasons, here is a snippet from one post that points to one of the major flaws in that dysfunctional branch of medicine, psychiatry. That being ...

There are no cures in modern Psychiatry. In fact, they wouldn't know a cure if it stood up and slapped them in the face.

No one is ever pronounced cured. Once you get to this point, you are just a few baby steps from opening the door to an Alice in Wonderland fairy tale world where the "science" itself is found to be more and more fraudulent, what with their stew of pills, and their quicky and highly profitable diagnoses. And you wonder at the ethical problems people sidestep when they discover this, and then choose to ignore it.

To be fair, this is a radicalizing moment. But then you need to decide what is at stake.

Speaking of psychiatrists, I saw mine yesterday as I do every two months or so. Despite being off-meds at his urging, I continue to see him just to be on the safe side. But I'm beginning to wonder how safe that side is. You see, I've had almost two years of not just being subsyndromal, but of being virtually non-syndromal and the last five months of that has been without the aid of medications of any kind and so I had to ask him if I even passed muster as someone with bipolar disorder anymore. His answer discouraged me.

"Once diagnosed, never undiagnosed. But once diagnosed, not always symptomatic."

We talked about this and my original diagnosis in 1989--that was eight psychiatrists ago--and how I think I never was anything more serious than perhaps a bipolar 2, but I was diagnosed in the days before bipolar 2 existed. We talked about bipolar disorder as a personality disorder and how that may be far more applicable to someone like me than the big old ugly diagnosis of bipolar disorder 1, manic-depressive and mentally ill.

It became clear to me after a few minutes that there was no budging my doctor on his view of once-diagnosed, always-diagnosed.

So I told him something.

"What's the point of treatment and going through years of agony and finally getting vastly better only to be told that there is no goal line I can possibly cross that will lead to me being undiagnosed?"

He didn't have an answer for me. Our appointment was over. But my concerns are not.

How is it that I can go along with the rules of the mental illness paradigm for almost 20 years and actually meet almost every conceivable endpoint of recovery and still be told I have the disorder? That doesn't strike me as fair, logical or particularly humane. In fact, I am feeling rather screwed over by this whole process that has consumed my entire adult life.

What if we, as a culture, told that to cancer patients? Would there be a movement of cancer survivors? Or would their be hoards of former cancer patients huddled in the corner, well but still diagnosed? You know the answer: we'd never stand for that.

I think it's high time we started examining what personality issues psychiatrists might have--and if you know anything about the history of the DSM, you know they have loads of issues of their own--and began a push to stop this nonsense of labeling people for life. Oh wait, there's already a movement like that.

Is it any wonder it's had little success given that even fairly humane docs such as mine buy into the Dx'd for life nonsense and that there's a $250 billion industry very interested in keeping people like me sick for life even when I am more well than most normal people I can think of?

Criticizing the Rise Of Bipolar Disorder In Adults and Children

Furious Seasons points us to an interesting new research paper, entitled

Pediatric bipolar disorder: An object of study in the creation of an illness:

David Healy and his colleague Joanna Le Noury have a new paper out, which examines the rise of bipolar disorder in both adults and children and puts it all in some kind of historical context. It's a lengthier examination of what Healy calls disease mongering than his PLoS paper of 2006. If you want to avoid my summary of this new piece, which I think is a withering attack on just about everyone in the mental health industry, then read their paper here (it's a .pdf file).

Among snippets he quotes in the lengthy report is this one:

"In 1996, a paper from an influential group, based at Massachusetts’ General Hospital, working primarily on ADHD, suggested there were patients who might appear to have ADHD who in fact had mania or bipolar disorder. This study had used lay raters, did not interview the children about themselves, did not use prepubertal age specific mania items, and used an instrument designed for studying the epidemiology of ADHD. Nevertheless the message stuck. Cases of bipolar disorder were being misdiagnosed as ADHD. Given the many children diagnosed with ADHD who do not respond to stimulants, and who are already in the treatment system, this was a potent message for clinicians casting round for some other option."

All of which sounds like some pretty awful research to me.
Both the Furious Seasons post, and the original research paper are worth looking at (link to PDF copy here). The article was published in the International Journal of Risk & Safety in Medicine, which also has an interesting paper with the cheery title Exposure to SSRI antidepressants in utero causes birth defects, neonatal withdrawal symptoms and brain damage

Zyprexa Suicide Victims’ Families Angry

From this report. If you do a blog search of "Eli Lilly and "Zyprexa" (their blockbuster) keywords you will find much negative blogging. Some of it is from claimants of their Zyprexa settlement who are still awaiting their promised resolution.

The family members of people who committed suicide after taking Zyprexa are understandably upset that they were not made aware of the risks associated with taking the drug. Patients as young as nine years old have reported having suicidal thoughts after taking Zyprexa and some adults have committed suicide.

Now, as more reports of people committing suicide while taking Zyprexa are made public, more family members realize that it may have been the drug, and not their loved one's disorder, that caused them to commit suicide.

One comment that is repeated over and over again by people complaining about the suicide risk in Zyprexa patients is that they were not suicidal before taking the drug. This is reported both by patients who took Zyprexa and the family members who have lost loved ones to suicide. Many people who took Zyprexa and complained about suicidal thoughts say they had never had such thoughts before taking the drug.

As one interview subject pointed out, before taking Zyprexa her life had been going fairly well. She was simply given Zyprexa to help treat bipolar disorder, but suicide had not been something that even entered her mind. However, within weeks of starting the drug, she became suicidal, coming to the point where every day was a struggle not to kill herself. She says that at the time she did not fully understand why she wanted to commit suicide, she just felt that she had to.

It was not until after her ordeal was over that she realized the drug she was taking could have caused her suicide attempts. Luckily, she survived her ordeal but countless others may not have. Their families could still be blaming their loved one's disorders for the suicide without realizing that Zyprexa could have led to their suicide. In fact, the rate of completed suicides linked to Zyprexa is higher than the rate associated with any other atypical antipsychotic, the class of drug that Zyprexa belongs to.

Some patients taking Zyprexa report that they have suicidal thoughts continuously and wake up trying to figure out how to commit suicide. Many have more than one suicide attempt and because their doctors do not realize that the suicide attempt is related to Zyprexa, the patients are given either an increased dosage of Zyprexa or a deadly drug combination that also increases their suicidal ideation.

It is a deadly cycle that rarely ends well for the patient. Those who complain about suicidal thoughts are often not taken seriously because, as patients diagnosed with mental disorders, their opinion is neither credible nor important. Unfortunately, because the medical and pharmaceutical communities are not listening to their concerns, patients are dying and their suicide is being blamed on their mental condition rather than on the drug they were taking.

It is not okay to dismiss someone's death simply because they had bipolar disorder or schizophrenia. Simply assuming that they committed suicide because of their disorder allows pharmaceutical companies to continue marketing their drugs as safe when they may not be. If Zyprexa is responsible for the death of loved ones, then family members have a right to know. Furthermore, future patients have a right to be properly informed of all risks associated with Zyprexa before they decide whether or not to take that particular drug.

If you have or a loved on has taken Zyprexa tried to commit suicide, please contact a lawyer who works with this sort of lawsuit, who can review your case at no cost or obligation.

A Decline in Psychiatric Salaries

It appears that it is becoming harder to make a living as a psychiatrist, or any other mental health counselor. We suspect that a hidden cause in this decline has something to do with the decline and fall of the profession itself, as more scandals rack psychiatry, and industry repute is left in tatters and shreds. Of course, they pin the blame on a number of other reasonable factors. But maybe they need to look in the mirror every once in a while, instead of trying to gain sympathy from government. People are reminded that if it wasn't for government funding, psychiatry as a medical specialty would be dead already.

From this report

When Heather Pierce sat down and did her taxes for last year, she was a bit surprised to learn that she earned only about $23,000 in 2006.

The Berlin psychiatrist said her income was far higher when she began practicing 20 years ago.

"I'm not looking for sympathy because I love what I do," she said this week. "But the reality is that I have not had a raise in four years."

More than a dozen Vermont psychiatrists working in the public and private sectors held a morning-long hearing at the Montpelier Statehouse on Tuesday and painted a picture of a mental health system that is nearing a crisis.

Years of low reimbursement rates from the government and the health insurance industry coupled with the difficulty in counseling Vermonters suffering from mental illnesses, a process that seems to defy traditional health improvement tracking, have brought the state's community system to a point of cracking, psychiatrists said.

"We need to keep these issues on the front burner," said Ken Libertoff, the executive director of the Vermont Association for Mental Health and the organizer of the meeting. "Otherwise over the next several years we will see this field greatly diminished."

Alice Silverman, a St. Johnsbury psychiatrist, said it is impossible to find an available psychiatrist for emergencies in the Northeast Kingdom. Those working in that area are booked for weeks, she explained, creating a major gap in mental health services in a troubled part of the state."There is not enough care," Silverman said. "The system is breaking. It's a crisis and this is shameful."

Jennifer FauntLeRoy, a Rutland psychotherapist, said her three years of sessions with a 40-year-old abuse survivor with serious health problems totaled $8,990 in costs. But the total amount paid by Medicaid ended up being just over $6,000, she said.

FauntLeRoy said sometimes she makes as little as 25 cents over minimum wage for the public mental health work she does. By comparison, she might make more than $30 an hour conducting private sessions for those who can afford out-of-pocket costs for sessions.

"I'm going to be out of business in five years if I continue getting Medicaid at this rate," she said.

Montpelier psychiatrist Francis Kalibat distributed a copy of Cigna Healthcare's preferred psychiatrist network in Vermont – the list of 15 doctors in the state that the company sends its consumers to.

Of those 15, Kalibat said he found only three who are taking patients right now. The rest of the list was full of out-dated information, doctors who have wait lists of up to a month even for urgent cases and one person who wasn't even a psychiatrist.

Kalibat referred to the list as "Cigna's phantom network of psychiatrists."

"If you are with Cigna, you are paying good money for a policy you can't use," he said.

Cigna Healthcare could not be reached for comment Wednesday.

Much of the frustration at the meeting was focused on the health insurance companies, and several psychiatrists expressed frustration at the recent news that officials such as former Blue Cross and Blue Shield of Massachusetts CEO William Van Faasen received about $19 million in extra compensation and bonuses last year – all while their own reimbursement rates are stagnant.

Leigh Tofferi, the director of government, public and community relations for Blue Cross and Blue Shield of Vermont, said its medical reimbursement rates are based on local and regional market rates.

Because the health care organization only has 200,000 members in Vermont – a small pool compared to most other states – it contracts its mental health services administration to Magellan Health Services, a Connecticut-based company, Tofferi said.

"My understanding is that the reimbursement rates are based on market analysis," he said. "We try to find a balance that will provide access and value for our customers."

Catamount Health – Vermont's new program for the uninsured that was rolled out this fall – also worries psychiatrists.

A provision in that law states that the "carrier shall pay a health care professional the lowest of the health care professional's contracted rate." Jonathan Weker, a psychiatrist from Montpelier, pointed out that members of his field are among the few that are subjected to contracted rates.

"This makes me wonder why I would want to become a Catamount provider," Weker said.

Christine Oliver, the deputy commissioner of Banking, Insurance, Security and Health Care Administration for Vermont, said that provision was added at the request of MVP Health Care.

"The problems with reimbursement rates for the mental health field seem to be a systemic issue," Oliver said. "The thinking was that it was better to address that and other access issues in specific legislation later on, which it seems the Legislature plans to do next year."

Rep. Michel Fisher, D-Lincoln, the vice-chairman of the House Human Services Committee, said that provision will be one of the issues he hopes to investigate when the second half of the legislative session begins in early January.

"The challenge for us is to boil down these concerns to a legislative agenda that is reasonable," Fisher told the group of psychiatrists on Tuesday.

Concerns over the health of the state's mental health system comes at a time when advocates and lawmakers will be looking to the coalition of psychiatrists across the state to take over the patient load that is now going to Waterbury's Vermont State Hospital.

Rep. Ann Donahue, R-Northfield, a prominent advocate for mental health issues in the Vermont House, said the community system needs a boost if lawmakers are going to shift away from the troubled and federally-decertified state hospital.

"There is a concern here that we really have lost some ground over the last few years," Donahue said.

Psychologist who evaluated sex offenders resigns over child pornography

Seen in the American Chronicle. As the seamy side of psychiatry becomes more well-known, practitioners are starting to get nervous.

A psychologist in North Dakota who conducted sex offender evaluations for the state has resigned over a self-admitted child pornography compulsion. Joseph Belanger had run the state's Sexually Dangerous Individual (SDI) civil commitment program. In that capacity, he evaluated sex offenders and testified in court that they were sexually dangerous and should remain hospitalized.

It was unknown what triggered the investigation against Dr. Belanger, but Homeland Security officials recently seized his home computer, according to the Forum newspaper in Fargo, ND.

Dr. Belanger had worked for the state hospital for more than 20 years.

He is at least the second forensic psychologist this year to be tarnished by accusations of sexual deviancy.

In July, prominent forensic psychologist Stuart Greenberg killed himself after being arrested on suspicion of voyeurism; he had allegedly secretly videotaped a woman in his office bathroom. Greenberg was known for his expertise in child custody evaluations, but he was also a consultant for the Archdiocese of Seattle in sex abuse cases.

In addition to their connections with the burgeoning sex offender industry, another commonality in these cases in that both men allegedly used modern technology to further their deviant interests - Greenberg using a concealed video camera and Belanger using the Internet.

[...]

What is relevant to the field of forensic psychology, however, is that the revelations will likely cause scrutiny of cases in which the two men were involved as expert psychologists. This scrutiny is already occurring in Greenberg's case, with parents protesting unfavorable child custody court decisions that were based in part upon his opinions. In King County (Seattle), the presiding judge anticipated a flurry of legal challenges to cases in which Greenberg was a court-appointed evaluator. Although Greenberg's arrest would not be sufficient to reopen a case, a parent could argue bias if Greenberg's custody recommendations hinged on a parent's sexuality. Similar challenges by civilly committed sex offenders evaluated or treated by Belanger in North Dakota can be anticipated.

[...]

From Embarrassment to Scandal: The expanding crisis of trust in psychiatry.

As Seen in the Carlat Psychiatry Blog - It look's like even the shrinks are starting to realize that something wrong is going on in the rancid world of psychiatry. The piece is sufficiently short that we can quote it in full:

What began as an embarrassment of Eli Lilly, PV Updates, and PRMS is gradually becoming a full-fledged scandal. The Indianapolis Star picked up the story last weekend (read it here), and psychiatrist David Port, M.D. wrote me a letter alerting me to an expanding crisis of trust in psychiatry. Here is an excerpt:

"Whatever Lilly's justification for sponsoring a course ostensibly to help the psychiatrist to better deal with professional liability risks, I am outraged that PRMS has accepted money from Lilly and has chosen to offer its authority and reputation toward this Lilly effort. PRMS is the American Psychiatric Association-endorsed entity which directs APA members to a selected malpractice insurance agency. PRMS is thus the agency many or most of us psychiatrists turn to for guidance and direction as to liability exposure and malpractice coverage. For PRMS to work for Eli Lilly is a glaring conflict of interest between their psychiatrist clients and a pharmaceutical corporation whose interests do not necessarily coincide with those of the psychiatrists with whom they have a professional relationship. This is analogous to the same law firm representing two individuals opposing one another in a law suit; in that situation we assume that there cannot be fair representation of either client, and we may imagine that the client with an attorney who has more clout in the law firm may well prevail in the action. How can we trust PRMS, or the APA for that matter, to provide us with the best liability support? David Port, M.D."

Yes, it's true. PRMS runs The Psychiatrist's Program, a malpractice carrier that is officially endorsed by the APA.

I know, it can get very confusing. Let's follow the money.

• Eli Lilly gives the APA at least $1.3 million in 2007 (so far) for industry-supported symposia and fellowships.
• Lilly then gives PRMS a bunch of money (Lilly refused to tell John Russell at the Indy Star how much) to produce a web-based slide show teaching psychiatrists how to prescribe potentially toxic medications like Zyprexa without being sued.
• The APA officially endorses PRMS' psychiatry malpractice insurance for its members.

Does APA receive any type of kickback for this endorsement? I assume that would be illegal, but who knows?

Look, I get as annoyed by conspiracy theorists as the next guy. But the web of money and influence here is so murky and repugnant that it leaves me wondering what's going on. [...]

Widow sues Tripler Army Medical Center over veteran’s suicide - Psychiatrist implicated

From Hawaii's Star Bulletin

The widow of an Air Force veteran who jumped from the 10th floor of Tripler Army Medical Center is suing the U.S. government for his death.

The medical malpractice suit, filed last Thursday in U.S. District Court, claims the staff at the hospital ignored the suicidal thoughts of retired Master Sgt. Robert Roth, 50, who worked as a clerk in the records section, said attorney Rick Fried, who is representing Roth's widow, Satsuki Roth.

Tripler, in a short statement, said, "The case will be vigorously defended."

Roth died Jan. 2, about two weeks after he warned doctors he wanted to leap from the top of the hospital or the Makapuu cliffs, according to an internal criminal investigation by the Army.

On Dec. 16, 2006, Roth, of Sioux Falls, S.D., had to "wait several hours" to see an assistant psychiatrist who later released him, saying "he appeared to be OK to go home," the Army report said.

Ten days later, Roth stormed out of the hospital against medical advice after experiencing another long wait caused by the emergency room having only one doctor during the Christmas holiday, it said.

"Twice he basically came to the emergency room, and they ignored him," Fried said yesterday. "He came with a backpack to be admitted."

On Jan. 2, Roth had a doctor's appointment but found the hospital closed because of the federal holiday observing President Gerald Ford's death. He got into the building through an emergency door that had its alarm turned off by other workers, walked up to the 10th floor and plunged 89 feet, landing on a web of air-conditioner pipes.

The suit will seek monetary damages that would be used to care for Satsuki Roth, 47; Robert Roth's 74-year-old mother, Joyce Ulmer; and his 23-year-old son, William Roth, Fried said.

Arkansas Medical Board rules spared druggie psychiatrist a background check

From the North West Arkansas News

The Arkansas State Medical Board didn’t uncover a new doctor’s April drug arrest in Kansas because he already held an inactive Arkansas medical license and renewals do not require fresh criminal background checks, board officials said Wednesday.

Crossett police officers arrested Paul J. Loop, former psychiatrist at the Ashley County Medical Center, on Dec. 3 after they found crack cocaine hidden in a Tylenol bottle in his pocket.

He joined the Crossett hospital’s staff in late November after resigning Aug. 31 from the Colmery-O’Neil Veterans Affairs Medical Center in Topeka, Kan.

A Topeka police officer arrested Loop just before 8 a.m. on April 17 after he found the doctor in a car sleeping next to drug paraphernalia.

Russ Sword, chief executive officer of the Ashley County Medical Center, was unaware that fresh criminal background checks are not required on renewals and questions the board’s process.

“Hospitals depend on the medical board,” Sword said. “If they don’t do anything, what is the point?” Loop, 46, graduated from the University of Arkansas for Medical Sciences in 1993. He first earned a state medical license in 1997, according to Peggy Cryer, executive secretary for the Arkansas State Medical Board.

The state board received an application to renew his license on Sept. 26.

Instead of a repeat background check, physicians renewing their licenses are only required to pay a fee and report whether they’ve been arrested or convicted of a crime.

Cryer said Loop reported that he had never been arrested on the renewal form.

Bill Trice, the state board’s attorney, said it’s logistically impossible to run background checks every time a doctor renews his license. There are about 10,000 doctors in Arkansas who must renew their licenses annually.

Also, the Arkansas State Police, the agency required by law to run the checks, does not have the capability to store fingerprints from year to year, Trice said.

“Can you see 10,000 physicians traipsing down to State Police headquarters to do a fingerprint card every year ?” Trice said. “We aren’t trying to stop doctors from practicing.” Lisa Robin, senior vice president with the Federation of State Medical Boards, said no state requires fresh background checks during license renewal because of the logistical challenges.

In fact, only half the states in the country have authority by law to conduct background searches at all, Robin said.

Psychiatrist arrested for crack cocaine possesion.

From the Arkansas Democrat Gazette. With any luck the guy would have been working in the hospitals' drug rehab program.

A south Arkansas doctor — with a previous history of drug arrests — faces two new felony charges after police say he got high and took crack cocaine to work last week. The doctor, Paul J. Loop, has since lost his job at the Ashley County Medical Center. The Arkansas State Medical Board suspended his medical license Friday and will decide whether to revoke it at a February disciplinary hearing.

Center CEO Russ Sword said Loop, 46, joined the Crossett hospital about two weeks ago as a psychiatrist. Crossett is about 10 miles from the Louisiana border.

Police interviewed Loop at the hospital on Dec. 3 after he told another employee that he had used crack earlier in the day, Sword said.

Crossett Police Department Investigator Shelbi Hughes said she found six crack rocks, worth about $ 250, hidden in a Tylenol bottle in Loop’s pocket.

Police also found drug paraphernalia in Loop’s room at the nearby Levee Inn.

Hughes arrested Loop on felony drug possession and paraphernalia charges. He could face up to 40 years in prison and a $ 25, 000 fine if convicted.

“It’s disappointing that he’s probably thrown away his career,” Sword said.

Loop has since posted bail and could not be located on Tuesday. He listed his mailing address to police as West Plains, Mo. Loop also faces charges in Kansas.

Kristi Pankratz, a spokesman for the Topeka Police Department, said Loop faces a pending charge out of her office for possession of drug paraphernalia.

Pankratz said a Topeka police officer found Loop asleep in a car outside a Topeka business just before 8 a.m. on April 17. The officer arrested Loop after seeing drug paraphernalia inside the car.

Court documents containing additional details on the case could not be obtained Tuesday.

The district court office in Topeka was closed due to an ice storm.

Loop worked for a number of years at the Colmery-O’Neil Veterans Affairs Medical Center in Topeka, said hospital spokesman Jim Gleisberg.

Gleisberg said hospital officials knew about Loop’s arrest. He resigned from the hospital on Aug. 31.

Sword said the medical center got Loop’s name through a recruitment agency.

The hospital also relied on the Arkansas State Medical Board to run a background check of Loop’s criminal history.

Sword questioned why the board’s service did not turn up information on Loop’s previous arrest.

“The Crossett cops quickly found out he has a record,” Sword said. “It seems to me that shouldn’t be too difficult to find out.

David Wroten, executive vice president of the Arkansas Medical Society, said all Arkansas hospitals are required to use the board’s service to run background checks and verify credentials.

The checks are considered very thorough.

“ If a doctor had a two-week hiatus between medical school and residency, they find out why,” Wroten said.

Bill Trice, attorney for the Medical Board, said the group’s credential-verification service uses an FBI database to check arrest histories.

The check turned up nothing to disqualify Loop.

Trice said it’s possible Loop obtained his license prior to his April arrest. That may be why the background check did not pickup the April arrest.

He did not know when Loop originally received his license.

Sword said Loop, who graduated from the University of Arkansas for Medical Sciences, had an “inactive license,” perhaps from pervious work in the state.

The board met Friday and approved an emergency suspension of Loop’s medical license, Trice said.

It could vote to permanently revoke Loop’s license at a disciplinary hearing scheduled for Feb. 8.

Psychiatric Hospital Deaths Lead to Firings

From the Philidelphia Inquirer

The head of Ancora Psychiatric Hospital and a security guard have been removed from their jobs following the suicide of a patient who was under 24-hour watch after a brief escape, state officials said yesterday.

Two other hospital employees - the assistants who were supposed to be watching the patient - have been suspended and could face further disciplinary action.

It was the second escape in three months by an Ancora patient who had been committed after having been found not guilty of murder by reason of insanity.

"We are sending a clear message that we recognize that the hospital has some systemic issues and is in need of immediate action," Ellen Lovejoy, spokeswoman for the Department of Human Services, said yesterday.

Lovejoy said an investigative team from Human Services headquarters in Trenton was at Ancora, in Winslow Township, and its findings likely would prompt further changes in operations, staff and management.

The highest-ranking casualty of yesterday's shake-up was Latanya Wood El, a 25-year veteran of the Department of Human Services and chief executive officer at Ancora since 2000. Lovejoy said Wood El would be reassigned; it was unclear yesterday what her new duties would be.

To replace her, Greg Roberts, assistant director of the Office of State Hospital Management, has been appointed acting director at Ancora. Roberts has run Ancora, as well as three of the state's four other psychiatric hospitals, in the past.

Human Services Commissioner Jennifer Velez had vowed to take action after Sunday's escape by DeWitt Crandell Jr. of Englewood, Bergen County, the son of a prominent Columbia University psychiatrist, who in 1996 stabbed his father more than 30 times with a nine-inch hunting knife. When his mother tried to intervene, he stabbed her to death, too.

On Sunday afternoon, using court-ordered unsupervised grounds privileges, Crandell left the Ancora property, which has a fence but no locked gates. He was discovered two hours later, naked, scratched and bleeding, walking along railroad tracks near Hammonton, Atlantic County.

Crandell was returned to the hospital and put under "direct supervision," meaning an around-the-clock watch that requires two hospital assistants to keep him at two-arms'-length reach at all times, according to Lovejoy.

About 3 a.m. Monday, Crandell hanged himself with a bed sheet in a bathroom between two patient rooms.

Although the two assistants assigned to Crandell have been suspended, Lovejoy said hospital officials continue to study security surveillance tapes to determine where, exactly, they were at the time.

The security guard who was relieved of his duties works for a firm that has a contract with the hospital. He will not return to Ancora.

The other recent missing Ancora patient was William Enman, who was gone for three days in September before he returned to Ancora and was found on the campus. In 1974, he beat his roommate and his roommate's 4-year-old son to death with a baseball bat.

Court reserves decision on ex-psychiatrist's murder conviction

From ABC News Australia. The case made spectacular headlines when it was first covered by the news outlets.

Former psychiatrist Jean Eric Gassy will have to wait until next year to learn whether the High Court will order a review of his conviction for the 2002 killing of Margaret Tobin, who was the head of South Australia's Mental Health Services.

The court has reserved its decision in the case.

Gassy has told the High Court today there was a miscarriage of justice because he was denied full access to legal help at the start of his trial and the jury was given instructions reflecting the prosecution case, but not the defense case.

Several of the High Court judges questioned the instructions given to the jury.

But lawyers for South Australia have told the court that although the judge should not have restricted Gassy's access to legal advice in the pre-trial period, it made no difference because his guilt was proved beyond reasonable doubt.

Gassy is serving a life sentence.

The case against him included allegations he had committed the murder as an act of vengeance for Dr Tobin's role in his being struck off as a psychiatrist.

The court will deliver its decision next year.

BC doctors double dipping - Clinic doctors got $500,000 in public funds, but walk-ins were charged for basic visits in violation of Canadian law

From this Report. There is also a lot more information in The Tyee

Doctors working at the private Copeman Healthcare Centre in downtown Vancouver received nearly $500,000 in fees charged to the public last year, though the clinic is also charging its 1,500 patients to use its services.

The top grosser in public funds was Tasha Bienert, a family physician at the clinic, who got $158,727 from the Medical Services Plan.

Psychiatrist Kevin Kjernisted was paid $120,568.

Another psychiatrist, Diane McIntosh, received $118,079.

Corporate medical director Peter House made $43,110 while family physician Beth Donaldson got $39,466.

The payments are recorded in the Medical Services Commission's annual financial report for the year ended March 31, 2007. Two other Copeman clinic doctors, Michael Koehle and Mark Gelfer, do not appear in the records. Nor for that matter does clinic founder and CEO Don Copeman, a businessman who once took pre-medicine courses.

It is unclear from the report how much of the fees paid to the various Copeman doctors was for work performed at the clinic, and how much was for work they may have done elsewhere. But medical director House says, "Nobody at Copeman works outside the clinic. We used to."

Besides whatever public money flows to Copeman clinic staff, the centre also charges patients a fee before they can see a doctor. To be seen by a doctor costs $3,900 for the first year, plus $2,900 for each year after that. That's up, by the way, from $3,500 for the first year and $2,300 annually when The Tyee reported on the clinic in May 2006.

Under the Medicare Protection Act, doctors who have "opted-in" and receive payments under the public Medical Services Plan may not charge a patient for any service normally paid for through public insurance. How then, are Copeman doctors charging twice?

In late November the government's Medical Services Commission, which oversees payments under the MSP program, ruled after an 18-month investigation that the private clinic on Vancouver's Hornby Street is operating legally, but it remains unclear how that decision was made...

Another lawsuit targets Ayres - former patient seeks civil damages

From this report

Dr. William Ayres, the prominent child psychiatrist awaiting trial on allegations that he molested seven pre-adolescent patients, has been slapped with a civil suit by another alleged victim.

The lawsuit, which does notcite Ayres by name, alleges that a 42-year-old man was molested by a child psychiatrist with a San Mateo practice when he was 10 years old.

That psychiatrist, identified in the suit as John Doe 1, is none other than Ayres, plaintiff's attorney David Drivon recently confirmed.

Under state law, when alleged victims of child sexual abuse file suit, they must use a fictitious name for themselves and those they are suing, Drivon said.

The alleged victim, identified in court documents as Manuel Doe, was "improperly touched" by Doe 1 and has since suffered "internalized shame, guilt, self-blame" and other complexes which have led to "loss of self-esteem, disgrace, humiliation and loss of enjoyment of life," according to the lawsuit.

However, Manuel Doe — who now lives in the Sacramento area, according to Drivon — is not one of the alleged victims cited by prosecutors in the criminal case against Ayres.

Prosecutors have been forced to build their criminal casearound patients who were allegedly abused by Ayres within the past two decades, due to the legal statute of limitations for child molestation cases.

The case of Manuel Doe, who was allegedly abused during the 1970s, is too old for prosecutors to cite in a criminal case.

However, like several dozen men whom county prosecutors allege were abused by the child psychiatrist over a period of decades, he is eligible to file a civil suit against Ayres.

Manuel Doe isn't just suing Ayres, Drivon said. He's also suing a "business entity" that employed the child psychiatrist in the city of San Mateo. The business, identified as John Doe II, is charged with failing to supervise Doe I or warn the alleged victim of the child psychiatrist's "dangerous propensities."

Additionally, the suit cites an unspecified number of individuals or organizations, identified as Does 3 through 300, who may be "liable in some manner" for the actions of Doe I.

Drivon did not confirm whether the "business entity" that employed Doe I is Peninsula Psychiatric Associates, the group practice where Ayres worked for years. He also declined to say whether any of the Does who may be liable are connected with the county's juvenile justice system, which sent Ayres thousands of youths in need of psychiatric evaluation.

The child psychiatrist's role as a "counselor and authority figure" enabled him to "assert control and influence" over Manuel Doe, according to the lawsuit.

"In his capacity as a psychiatric professional and by his words and actions, (Doe I) assured (Manuel Doe) that (his) conduct was proper," the lawsuit states.

The lawsuit, filed in October, has not yet been served. Calls to Ayres' criminal defense attorney, Doron Weinberg, were not returned before press time. Neither were calls made to Donald Putterman, the attorney who represented Ayres in a 2003 civil suit alleging that the child psychiatrist molested a former patient.

The 2003 suit was settled outside of court for an undisclosed amount in 2005. The recent action filed by Manuel Doe, seeking unspecified damages, is the first known civil suit to be filed against Ayres since his arrest earlier this year.

In the criminal case, Ayres is expected to appear in the Hall of Justice on Dec. 17, where his defense attorney is scheduled to argue a motion that law enforcement violated the client-psychotherapist privilege by issuing a search warrant for Ayres' patient files.

Those files provided the basis of the criminal case against Ayres, according to prosecutors.

Ayres remains out of custody on $750,000 cash bail.

Brain scans, the new snake oil

A reaction to an OpEd piece from the LA times

In an Op-Ed piece in the Dec. 5 L.A. Times, self-proclaimed "neuropsychiatrist and brain-imaging expert" Daniel G. Amen attempts to convince us that "three of the last four presidents have shown clear brain pathology." Starting with Ronald Reagan's Alzheimer's disease, which was never in dispute, he proceeds to Bill Clinton's moral lapses as indicating "problems in the prefrontal cortex" and Bush's emotional rigidity as a symptom of temporal lobe pathology.

Even the non-medical reader will have a sense of sweeping generalization in these pronouncements. If every moral lapse indicated "problems in the prefrontal cortex," most of mankind could be said to have disordered frontal lobes. And, if all the emotionally rigid people in this world were tallied, a large proportion of mankind would have disordered temporal lobes. Disconnects in Amen's logic include: first, there is no agreed-upon standard for evaluating moral lapses and emotional rigidity; second, brain imaging cannot detect attributes of individual personality; and third, there is no direct correspondence between obvious frontal or temporal lobe brain disease, including Alzheimer's, and the behavior Amen would attribute to these brain areas.

On his website, Amen lists "14 reasons to get your brain scanned at Amen clinics." One particularly outrageous claim is, "Even if you are not having trouble, SPECT scans can help check the health of your individual brain." Implicit in this claim is that Single Photon Emission Computed Tomography, which requires an intravenous injection of radioactive material and very expensive imaging equipment (and therefore high cost to the patient), will be correct every time. Nothing could be further from the truth.

This kind of hucksterism is not new to psychiatry. In 1964, psychiatrists responding to a poll attempted to "diagnose" presidential candidate Barry Goldwater by his political pronouncements as clinically paranoid. Charles Krauthammer, a psychiatrist himself, rightfully characterized this as a "shameful ... misuse of medical authority." Because of this episode, the American Psychiatric Assn. developed an ethical principle, the "Goldwater rule," which states that, "On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination [emphasis added] and has been granted proper authorization for such a statement." Clearly, violations of this ethical principle continue.

There are further instances. The medical profession, psychiatrists included, is coming under increasing scrutiny for excessive promotion of new drugs and medical devices. For example, in an August 2002 Stanford University news release, Dr. Alan Schatzberg, chair of Stanford's Psychiatry Department, stated that treatment of psychotically depressed patients with the abortion drug, RU-486, "may be the equivalent of shock treatments in a pill.…" Given that electroconvulsive therapy is the most effective treatment for such patients, this was a hugely exaggerated claim, particularly because there was no significant evidence for effectiveness of the drug at that time. (Indeed, later FDA-monitored clinical trials also have been uniformly negative.) The possible commercial connection? Schatzberg is a co-founder and major shareholder of the company established to market RU-486 as a treatment for psychotic depression, and in 2002 the company was preparing for an initial public stock offering.

A very recent example is the Nov. 11 New York Times Op-Ed, "This Is Your Brain on Politics," written by seven research scientists, including three from FKF Applied Research (on its website, the company calls itself "The Leader in NeuroMarketing"). The article describes the functional MRI brain scans of swing voters who were shown political pictures while in the scanner. Based on which areas of the brain were activated by particular pictures, the authors offered conclusions such as "Hillary Clinton and Rudy Giuliani are on opposite sides of the gender divide," "Mitt Romney shows potential," "Fred Thompson ... evokes more empathy (than Rudy Giuliani)" and "John Edwards has promise — and a problem." One presumes this is saleable information to political campaigns. In swift reaction, a Nov. 22 editorial in the scientific journal Nature harshly criticized this "questionable scientific research," calling it "a great disservice to science" and "a great deal for the company."

So, what to make of all this? The adage, caveat lector et emptor, applies well here — let the reader and buyer beware. Ask trusted professionals for their perspective and advice. Hype, if not outright hucksterism, unfortunately is all too frequent in medicine, whether it is the latest expensive drug, or technology such as brain scanning. But, considering the snake oil of old, hasn't it always been so?

Robert T. Rubin, a board-certified psychiatrist, is professor and vice chair of the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, and chief of psychiatry and mental health at the VA Greater Los Angeles Healthcare System.

Regarding the two Shootings in Colorado

Currents reports are suggestive that Matthew Murray was influenced by psychiatric medication, as is too common this day in many public shootings:

At Abeyta's side was Peter Warren, the school's director. Warren said that when Murray came to the school early Sunday asking to stay the night, staff members did not recognize him.After Murray was identified by police, the school realized he had attended its training program in 2002. The Arvada school is a branch of an international missionary program that trains thousands annually.

Warren said school officials refused to assign Murray to a mission because of an unspecified health problem that could make such work unsafe. Warren would not elaborate, and he and Abeyta left without taking questions.

But this is not nearly enough evidence to say it was so, despite the odds in favor of such a conclusion. And to be fair, a person can be on unbalanced mind for reasons not having to do with psychiatric drugs. Uncommon, but it happens.

In court papers, police said Murray had written threatening letters to the school and spent many hours a day on the Internet as a computer student, the Gazette of Colorado Springs reported. [...] It also was unclear why Murray traveled the roughly 75 miles from the missionary school in Arvada to New Life Church, which has a Youth With a Mission branch office. New Life achieved notoriety last year when its founder, Ted Haggard, was accused by a former gay prostitute of trading drugs and sex.

Information is unclear at this time, and we await further reports.

More foster kids getting drugged.

From a much longer article in the Rochester Democrat and Chronicle. There are also a number of heart wrenching letters in the comments section following the original story, indicating the horrific need for political reform in the foster care system.

When Laticia Anderson's son entered foster care in 2005, a social worker described the 4-year-old as "an extremely smart little boy who loves school."

But over the next six months, as he was shuttled from an emergency foster-care placement to two foster homes, his personality changed.

The boy would explode in tantrums, gouge his own flesh, even consider killing himself. Social workers and pediatricians could not quell his outbursts.

Frustrated, they resorted to Depakote, an anti-seizure medication intended for adults but occasionally given to children to alter their moods.

And then her son's personality really changed, Anderson said. The boy she knew as playful and exuberant was, when she visited him, distant and withdrawn - "almost like a zombie."

Like Anderson's child, hundreds of foster children in Monroe County each year are placed on psychotropic, or mood-altering, drugs. Though questioned in some medical and psychiatric quarters because of long-term health risks, the use of the psychotropic medications on foster care children in Monroe County is on the rise, a Democrat and Chronicle investigation shows.

The investigation included analyzing data from county, state and federal agencies; interviewing experts locally and nationwide; interviewing families of some local foster children on medications; and reviewing public records of Monroe County Family Court cases in which the prescription of the drugs has been an issue.

The investigation reveals that:

• In 2002, about a third of the county's foster care population, 327 children, were prescribed one or more common psychotropic drugs. By the end of 2006, the number had increased about 40 percent to 457 foster children, or almost half of the county foster care population.
• In the five years from 2002 through 2006, according to state data, Medicaid expenditures for common psychotropic medications for Monroe County foster children nearly doubled - an increase almost four times the statewide rate.
• Psychotropic medications are also more commonly used at residential foster care treatment centers than in the past, according to medical and psychiatric staff. At the nonprofit Hillside Children's Center, for instance, 55 percent of the foster children are prescribed one or more psychotropic drugs.
• 2006 records show that more than one of every eight foster children in Monroe County is on some kind of drug to combat psychosis, a severe form of mental illness characterized by lost contact with reality.
• Very young children are also prescribed the psychotropic medications, according to county data.

Last year, a 1-year-old foster child was prescribed the antipsychotic drug Risperdal, and two 4-year-old foster children were prescribed Depakote. Pediatricians say Risperdal and Depakote, if properly monitored, can be safely prescribed for young children, but some medical experts worry about possible health effects. Risperdal has been associated with heart disease in older adults; Depakote has been linked to liver failure in children younger than 2.

Drugs a straitjacket?

Foster care advocates say children are a particularly vulnerable population, often invisible to the public and beset with higher rates of mental and emotional illness in large part because of the disruptive - and sometimes abusive - lives they've led.

This leads to a conundrum: Are foster children legitimately prescribed psychotropic drugs more commonly because they have so many needs? Or are the drugs used more as a convenient way to straitjacket troublesome behavior?

The use of such drugs "definitely has gone up, and I say that with much reluctance because I don't think these medications are necessarily safe medications," said Dr. Mohsen Emami, a staff psychiatrist at St. Joseph's Villa in Greece, a nonprofit residential facility for troubled youths.

Across the country, while the use of psychotropic medications for all children has increased, the rate of use for those in foster care has grown even faster. By some estimates, foster children receive psychotropic drugs at a rate two to three times that of other children.

"I have no doubt that many, many kids are overmedicated," said Dr. Martin Irwin, a Syracuse-area psychiatrist who has been contracted by counties and treatment centers around the state to help decrease the use of psychotropic drugs for foster children.

"It's out of control in general, but the worst problems are in foster care because there's basically nobody advocating for the kid."

There is also much more in this follow up article

A Democrat and Chronicle investigation shows an escalating use of psychotropic medications for foster children in Monroe County — reflecting a national trend. Some experts say that's because foster children have far greater rates of mental illness and emotional disturbance than other kids.

Yet physicians and lawmakers nationwide now fear that the increasing prescription of the drugs, without ironclad assurance of their safety, could be sentencing foster children to physical or mental ailments later in life. Two trends are especially worrisome:

• Many psychotropic drugs prescribed to children and teens have not been tested for effectiveness or safety in youths.
• The prescription of multiple psychotropic medications for individual children, such as Jessie Sayyeau, has become more common.

[...]

Eight years ago, between 75 percent and 80 percent of the drugs prescribed for children had not been studied for pediatric use, said FDA's Murphy. In 2002, Congress passed laws providing financial incentives to companies that conducted pediatric testing on medications. Under the law, the companies were granted exclusivity, meaning the time was extended before competing generic brands could be approved and reach the market.

Murphy said regulators are seeing results, but many drugs already commonly prescribed off-label probably won't be tested for pediatric use. A March study by the U.S. Government Accountability Office estimated that about two-thirds of drugs prescribed for children are used off-label, which, the report said, "places children at risk of being exposed to ineffective treatment or incorrect dosing."

Many critics say that, despite the congressional action, far more needs to be done.

"If the United States does not build a more adequate system for studying and monitoring drug safety, then it's reasonable to think, down the road, we're going to see (side effects) in children that are going to surprise us," Zito said.