Two Top Liability Risks for Psychiatrists: Patients with Suicidal Behavior and Psychopharmacology

Snippets from a Press Release by PRM, still relevant today

Patient suicides may trigger the most lawsuits, but according to PRMS data, cases with the largest verdicts or settlements don't involve the death of a patient, but significant and permanent physical and neurological damage requiring lifelong care. Such damage can occur from things like renal failure from lithium toxicity, severe Stevens-Johnson Syndrome or brain damage from a suicide attempt.

"Defensive medicine is not the answer," said Jacqueline Melonas, RN, MS, JD, Senior Vice President of Risk Management for PRMS. "Care that has a sound clinical basis that also is well-documented is the best way to avoid or, if necessary, defend lawsuits."

[...]

Donna Vanderpool, MBA, JD, Assistant Vice President of Risk Management for PRMS, noted that breach of duty or negligence is just one element of a malpractice lawsuit. Other elements include duty of care (to meet a standard of care), damages or harm to the patient, and causation (the harm was caused by the breach).

"A plaintiff has to prove all four elements to win a medical malpractice lawsuit," Vanderpool noted.

During the session, PRMS also focused on another high-risk area for psychiatrists: psychopharmacology.

"Most psychiatric ailments are treated at least in part with medication, and much can go wrong when prescribing," said Denita Neal, JD, a Risk Manager with PRMS. Issues might include prescribing negligently, failing to monitor the medication or failing to obtain inadequate informed consent.

QUESTION: Where in the world could you go to find a place where half of all women are raped? ANSWER: Australia’s psychiatric hospitals.

Came across this news item from last year.

Still worth posting about

That’s the shocking conclusion of a new report from the Victorian Mental Illness Awareness Council (VIMIAC).

Their survey of women who have been in psychiatric wards in Victorian hospitals paints a shocking picture.

A terrifying 85 per cent said they had felt unsafe, with most saying they reported it to doctors and nurses and felt nothing was done. About 45 per cent had been sexually assaulted in hospital.

Just imagine the terror. You are alone, in a foreign place, completely under the control of medical staff, many of whom you have only just met, and surrounded by very disturbed people.

Even worse, you are disturbed: so depressed you unable to defend yourself, or perhaps already being tortured by fears, feelings or voices. There is a good chance you have a previous history of being assaulted, as such attacks vastly increase your chance of developing a mental illness.

It’s sickening. It’s happening now. And we are standing by and doing nothing.

“We expect people with mental illness to tolerate what no-one else would tolerate,” says Isabell Collins from VIMIAC. “It would only need to happen once in a general hospital ward and it would be fixed immediately.”

Yet, says Collins, she has been working in mental health for 25 years, “and sexual assault has been a problem for 25 years”.

Her survey included about 50 women from Victoria, but Collins says it does not overestimate the problem.

“If anything it underestimates it,” she says. “If you did the exact same survey in any state you would expect the same results”.

How could this be? How can we allow our most vulnerable people to be treated in this way? It’s hard not to agree with Collins that the answer is that society would rather just ignore mental illness, scared off by stigma and misinformation and a desire to sweep difficult problems under the carpet.

The incoming head of the Royal Australian and New Zealand College of Psychiatrists, Mal Hopwood, says that while he can’t be sure on the exact proportion of women raped in care, there is clearly a problem that exists around the country.

“Certainly the numbers in that report suggest it’s not an insignificant problem,” he says.

He wants hospitals to be properly funded to enforce female-only areas and support women who are assaulted.

But he says fixing buildings and allocating spaces won’t be enough: an attitude change is needed as well.

You also have to wonder if our over-reliance on medication and biological psychiatry have helped downplay the importance of creating positive environments in psych hospitals.

After all, if mental illness is just a brain disease that needs the right medication, then surely a stark, busy, hospital environment will make no difference?

But mental illness is closely linked to both our personal experiences and the culture we are living in, and putting people in scary, loud and under-resourced hospitals cannot be helping.

I couldn’t have more admiration for many of the hard-working doctors and nurses working in public hospital psychiatric units, yet the truth is that most of these places are awful to be in.

Rape is the terrible tip of a huge problem that we have been ignoring for far too long.

Psychiatrist and Fox News Channel analyst Keith Ablow freely mixes psychiatric assessments with political criticism, a unique twist in cable news commentary that some medical colleagues find unethical.

Commentary by David Bauder as seen on the Website for Channel 10 WISTV in Columbia, South Carolina.

Here are some snippets from the column, with my own brief comment. I recommend that you read it in full at the link above

[...]

He's been a Fox contributor since 2007 after hosting a failed syndicated talk show. Identified as a member of the Fox News Medical A-Team, he hosts a regular segment about behavior titled "Normal or Nuts?" on the "Fox & Friends" morning show. There were published reports this fall that the network had extended his contract.

Rival news networks CNN and MSNBC say they don't have a psychiatrist-commentator under contract. CNN said the closest thing it has to something similar is when profilers come on the air to discuss the mental characteristics of people who commit dramatic crimes, for example. The network said medical experts don't get into politics, but others can have different interpretations. The MRC's Graham said opinion often drifts in when television medical correspondents comment on aspects of Obama's health care plan.

Ablow clearly enjoys being provocative, and his commentaries don't stick to his areas of medical expertise. Within the past two weeks he called for an "American jihad," saying the country should urge all nations to adopt a government form based on the U.S. Constitution. His comment this summer that Michelle Obama "needs to drop a few" pounds was widely noticed.

[...]

Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University's College of Physicians and Surgeons, said Ablow seems more interested in entertaining than in reflecting well on his profession. Lieberman is past president of the American Psychiatric Association, which discourages members from speculating on psychiatric characteristics of non-patients.

"It is shameful and unfortunate that he is given a platform by Fox News or any other media organization," Lieberman said. "Basically he is a narcissistic self-promoter of limited and dubious expertise."

Ablow isn't an APA member, having resigned in 2011 in a dispute over transgenderism.

It's not unusual for there to be an uncomfortable relationship between the medical community and doctors who get into television. Talk show hosts Dr. Phil and Dr. Oz have their critics. Dr. Drew Pinsky took heat for exposing rehab patients to the pressure of a televised recovery.

While doctors are entitled to political opinions like anyone else, the way Ablow tries to connect his views to medical analysis "is really just irresponsible and it's embarrassing for physicians in general," said Ford Vox, a staff physiatrist at the Shepherd Brain Injury Rehabilitation Center in Atlanta.

Ablow has occasionally taken heat from Fox colleagues about his commentaries. Greg Gutfeld of "The Five" said that "we should probably avoid blaming people for tragedies," in response to Ablow's criticism of Obama on Ebola. And the four women co-hosts of "Outnumbered" clearly didn't appreciate the attack on the first lady's weight, made in context of her efforts to promote healthy eating.

Keith Ablow is a doctor without ethics, and is likely accusing President Obama of the the very things that Mr. Ablow is suffering from himself. Things like "severed himself from all core emotions." and so much more. Mr Bauder has done a great service in pointing out the professional hypocrisy and lack of ethics of Mr. Ablow. Too bad that Fox news has decided to profit from his lack of ethics instead of upholding professional standards.

We also note several followup columns on Mr. Ablow such as these

The strange case of Dr. Keith Ablow [Politico]

White House Foolishly Ignores Insights Of Fox ‘Dr.’ Keith Ablow, World’s Worst Psychiatrist [Wonkette]

Fox’s Keith Ablow Doubles Down on Psychoanalyzing Obama as a ‘Narcissist’ [Mediate]

Which is hilarious since Mr. Ablow is ever so likely to be a Narcissist himself.

Of course, he had to something to defend himself, not that it did him any good

Fox’s Keith Ablow fires back after fellow psychiatrists denounce him as a hack

Media Matters posted a mashup of some of Ablow’s past commentaries on Friday, which can be seen below.



On the basis that he is guilty of what he is accusing the President of, Keith Ablow is Toxic, and it is dangerous for your mental health to believe Keith Ablow.

While there may be plenty of legitimate reasons to dislike and and disagree with President Obama, those of discredited psych Keith Ablow are dangerous to American Politics.

Lawyers ask federal judge to declare state violates rights of mentally ill defendants

As seen in the Daily Reporter

SEATTLE — Lawyers for mentally ill defendants who are forced to wait in jail cells for months for competency evaluations and treatment have asked a federal judge to issue a ruling that says Washington's health services agency is violating the inmates' constitutional rights.

A federal lawsuit filed by lawyers from the American Civil Liberties Union and Disability Rights Washington is scheduled to go to trial on March 16. But late Thursday, the lawyers filed a motion for summary judgment.

The motion argued that mentally ill defendants, many arrested on misdemeanor charges, are held in jails for up to 60 days awaiting competency evaluations. If found incompetent, they're held in jails again waiting to go to the hospital to have their competency restored so they can help with their defense. The motion said this is happening because the state's two psychiatric hospitals are overcrowded.

The lawyers asked U.S. District Judge Marsha Pechman to rule that withholding services violates the defendants' due-process rights. Last week, Pechman granted the lawyers' request to certify the case as a class-action, which means it will apply to all mentally ill defendants in the state who are on the wait lists.

David Carlson, a lawyer with the disability rights group, said they sought the summary judgment to narrow the issues they'll deal with at the March trial.

"We are asking to court to look at the uncontested facts and apply the law," he said. "We believe that given that everyone agrees there are significant delays in people receiving evaluation and restoration services from the two state psychiatric hospitals, the court can rule on whether the law is being violated."

If the judge rules that the Department of Social and Health Services is violating the law by not providing the services, "the trial would focus on what remedies can be crafted to deliver timely evaluation and restoration services to the class members currently sitting in jails across the state," Carlson said.

[...]

One document filed in the lawsuit details the hundreds of defendants impacted by the waitlists. It said that Eastern State Hospital reported on Oct. 24 that 60 people were in jails waiting for competency evaluations or treatment: 44 had waited for more than a week; 19 had waited form more than 35 days; and three waited for more than 56 days. Western State Hospital reported that 144 people were in jails waiting to get into the hospital.

More info at the linked story

Robin Williams had the Anti-Depressant Mirtazapine in His Body When He Committed Suicide, According to Coroner's Toxicology Report

Recent major news reports have said that there were no drugs in the body of Mr. Williams, according to the just released toxicology report from the Coroner. A closer reading reveals that there were no illegal drugs in his system, but that there were certainly prescribed drugs.

As seen in this Report in Radar Online

Investigators found that he had been prescribed a variety of drugs, including lansoprazole, rapaflo, finasteride, amoxicillin, quetiapine, carbidopa, and mirtazapine.

Toxicology reports showed he had mirtazapine, desmethylmirtazapine, caffeine, and theobromine in his blood at the time of his death, but no alcohol.

And also in this report from the NY Daily New

Robin Williams had no illegal drugs or alcohol in his system when he hanged himself in a shocking suicide last August, the Marin County Coroner said.

The Oscar-winning actor had only prescription medications in his body and was suffering from depression, Parkinson’s disease and a "recent increase in paranoia,” the final autopsy report released Friday and obtained by the Daily News said.

[...]

Williams also “had complained in the past about not liking the way some of his medications made him feel,” the report said.

Toxicology testing found the antidepressant Mirtazapine as well as caffeine and the Parkinson’s mediation Levodopa in his blood.

The Marin County Sheriff's office issued this short press release {PDF] which was very short on details. We have never been a fan of AntiDepressants, especially as they do not seem to address the root causes of the Depression.

We are greatly saddened by the loss of Mr. Williams, and feel he could have been better served.

The film 'Mental Hospital' shows life inside a 1950s Oklahoma psychiatric facility

The film 'Mental Hospital' shows life inside a 1950s Oklahoma psychiatric facility



Discussed in great detail here in a great article by by Jaclyn Cosgrove

Actually, Fred is a character in “Mental Hospital,” a film produced in 1953 that shows what life was like for patients in Oklahoma’s mental health institutions.

From what I can gather, the film was produced by the University of Oklahoma for the Oklahoma State Department of Health and the state mental health agency.
Interestingly enough, the film was produced the same year that the agency now known as the Oklahoma Department of Mental Health and Substance Abuse Services was formed.

The agency was established through the Mental Health Law of 1953, although publicly supported services to Oklahomans with mental illness date back to early statehood.

“Until the mid-1960s, the primary means to treat mental illness was institutionalization in large state hospitals. On an average day in 1960, nearly 6,400 Oklahomans were in the state’s mental hospitals,” according to the agency.

The film “Mental Hospital” gives us a glimpse of how mental illness was viewed and treated 61 years ago.

I should note: Over the past several years, treatments have changed, and there’s more focus on understanding mental health issues as medical conditions.

Viewers follow Fred from the day he’s admitted to discharged, including the “insulin shock therapy” that he receives to treat his schizophrenia. This happens about 12 minutes into the film.

The preferred name for this treatment was “insulin coma treatment,” according to this long historical guide on the treatment. By 1962, most of these units had closed throughout the U.S.

Once stable, Fred is offered a job as a grounds keeper.

"What a difference it makes,” the narrator says, “At last, Fred can be outside once more, working, enjoying the sun and the seasons."

Not long after Fred gets his job at the hospital campus, wife Betty and his friend George come to visit him.

At 17:24, we see a psychiatrist talking with Betty and George.

"It's not too long 'til the psychiatrist decides that Fred can try it for a while at home,” the narrator says. “He talks with Betty and with George, helps them to understand that they too have vital roles to play in aiding Fred to adjust successfully to the world outside."
This is something that so many family members say gets left out of present-day treatment.

In interviews I’ve had, people have said they’ve been quoted federal health care privacy laws and left out of their loved one's discharge plan. Sometimes, their family members are discharged without them knowing.

By the end of the film, Fred’s doctor gives him a cigarette, and he collects the crafts he has made at the facility. We learn that Fred has been there for six months.

"If I'd come here sooner, I might have been out in three,” Fred says. “But all I could think about was fear, the way everyone was all against me, how much I hated George. How wrong I was. Or no, not wrong — sick. And now that I'm well again, I can't help feeling just a little sad, the way you always feel when you leave a place where you've lived, learned and grown, but I am well, and I know it."

 Of course, they will try to paint a positive pretty face on all of this. Even though this was a period of history renowned for their failures. (I'm looking at you Lobotomy)

The Australian Medical Association has joined calls for Perth's Graylands Hospital to be closed, saying mental health patients are being forced to live in 19th-century conditions.

As Reported by Perth Now

The Australian Medical Association has joined calls for Perth's Graylands Hospital to be closed, saying mental health patients are being forced to live in 19th-century conditions.

Western Australia's largest psychiatric facility came under the spotlight after the acting director-general of the health department, Bryant Stokes, told a parliamentary committee he wanted to "blow up" the "archaic" facility.

Professor Stokes said he hoped a decision to close Graylands would be made in the next few years.

AMA WA president Michael Gannon said the living conditions of mental health patients had not kept up with the times.

"We should not force mental health patients to live in 19th-century conditions," he said.

"We hope Professor Stokes' comments will spur the state government into action."

Dr Gannon said some patients needed treatment in specialised long-term facilities that did not have to be within a mental hospital.

Alison Xamon, of the WA Association for Mental Health, agreed the hospital was hopelessly outdated.

"It's not somewhere you would want to go ... or somewhere that you'd want to send a loved one," she told Fairfax radio.

Ms Xamon said if Graylands was sold off, the money should be reinvested in mental health

Dr. William Lewek, the Rochester NY psychiatrist accused of burying a dead man in his backyard will go to trial Feb. 23, 2015

As Reported in The Democrat And Chronicle

The Rochester psychiatrist accused of burying a dead man in his backyard will go to trial Feb. 23, a judge ordered Thursday.

Monroe County Court Judge Christopher S. Ciaccio also placed additional travel restrictions on Dr. William Lewek, ordering that Lewek can not leave Monroe County — aside from travel for medical care in Erie County and to visit family in Oneida County — unless he obtains court approval.

The travel restrictions were ordered at the request of First Assistant District Attorney Kelly Wolford, who told Ciaccio that Lewek's past actions gave her concern that he was a flight risk.

Lewek had been hospitalized after a bizarre incident in September in which he drove his car down an embankment and walked into the Niagara River in Erie County. He was rescued from there.

Wolford said Lewek's traveling along the Canadian border, combined with his substantial financial resources gave her concern he may try to leave the country.

Lewek's lawyer, Matthew Parrinello, said the restrictions were "totally unnecessary" and that the accident in the Niagara river was only that, an accident. Lewek is free on $250,000 bail. Prior to his trial, motions will be argued in the case on Nov. 19 and a Huntley hearing to argue the admissibility of statements Lewek allegedly made to police will be held Jan. 7.

Lewek is accused of burying the body of Matthew Straton in his backyard of his city home in October 2013. Lewek is accused of tampering with evidence — the allegation that he tried to hide Straton's body — and possession of crack cocaine in his home. Lewek allegedly told police that Straton died in his home.

Wolford told Ciaccio Thursday that an autopsy has been completed and prosecutors will not be superseding the current indictment with a new one charging Lewek with additional crimes.

Straton was reported missing in October 2013, shortly after he disappeared. His body was discovered behind Lewek's home on Rowley Street in January.

Straton's mother, Kym Straton, was joined by a dozen family members and friends in court Thursday. She said she is relieved a trial date has been set and things are moving forward.

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

Maine's Riverview Psychiatric Center has failed to abide by the terms of a decades-old consent decree by not adequately reducing the risk of injury to clients and staff and by arbitrarily limiting treatment options for patients

As reported in the Portland Press Herald

Further details at the link.

Riverview Psychiatric Center has failed to abide by the terms of a decades-old consent decree by not adequately reducing the risk of injury to clients and staff and by arbitrarily limiting treatment options for patients, according to a report issued by a former court-appointed receiver and consultant.

Elizabeth Jones was asked to report on observations she made during a three-day visit to Riverview, where the state treats its most severe mental illness cases, including patients sent there through the criminal court system.

Jones listed failures in treatment strategies, failure to provide proper interventions following aggressive acts by two patients and continued risk to patients and staff, a “serious misunderstanding of recovery model” that the hospital ascribes to, and lack of treatment and of outdoor time for Lower Saco unit patients, those who have been found not responsible for criminal conduct because of mental illness.

“Treatment options have been arbitrarily limited and, therefore, the provisions of the consent decree have been violated,” she wrote.

She said the use of seclusion and restraint need to follow consent decree requirements.

“At this time, it appeared that the requisite pro-active alternatives to seclusion and restraint have not been explored or provided consistently to the extent needed,” she wrote. “The lack of individualized treatment interventions and the lack of sufficient training and personnel support place both staff and class members at the risk of harm.”

Jones had a number of observations, including concerns that the state is no longer in compliance with the consent decree that requires individualized treatment plans and adequate staffing. The consent decree settled a lawsuit brought two decades ago by mental health advocates that holds the state mental health system to agreed-upon standards of care.

Daniel Wathen, the court master who oversees the consent decree, requested the visit following a series of problems at the hospital in Augusta, including serious attacks by patients on mental health workers and nurses, the use of a stun gun and pepper spray on patients, and a loss of federal funding estimated at $20 million annually because the Centers for Medicare and Medicaid Services had withdrawn the hospital’s certification.

Jones’ report was made public on Wednesday, though Wathen said he and Jones met immediately after the hospital visit with the commissioner of the state Department of Health & Human Services, and the hospital received a copy of the report on Monday.

Dr, Zahid Imran, an owner and operator of community mental health centers in Baton Rouge, Louisiana, has broken all records of fraud in the American health system.

As Reported on Geo TV

A Pakistani origin American doctor, an owner and operator of community mental health centers in Baton Rouge, Louisiana, Dr, Zahid Imran has broken all the records of fraud in the American health department.

After proof of $258.5 million fraud, the court convicted and sentenced him seven year in jail and a fine of $43.5 million.

His accomplices in this fraud were also sentenced. Chief U.S. District Court Judge Brian A. Jackson of the Middle District of Louisiana imposed the sentence.

The FBI , Health Department and Inspector General Louisiana had file a case in the courts of Louisiana where for doctor’s role in a $258 million Medicare fraud scheme regarding psychiatric services that were unnecessary or never actually provided and hefty payments were taken from the American health department.

As part of the scheme, Dr, Zahid Imran admitted mentally ill patients to the facilities, some of whom were inappropriate for partial hospitalization, and then re-certified the patients’ appropriateness for the program in an effort to continue to bill Medicare for services.

Imran and others falsified patient treatment records to reflect services on dates when no such services were provided.

The investigation of three community mental health centers; Shifa Community Mental Health Center of Baton Rouge (Shifa Baton Rouge), Serenity Center of Baton Rouge (Serenity Center), and Shifa Community Mental Health Center of Texas (Shifa Texas) were used in fraud which has resulted in the convictions of 17 individuals employed by the facilities, including owners and the medical director, therapists, marketers and administrators.

According to court documents, the companies billed Medicare more than $258 million over a period of seven years.

All these people have been booked for fraud and scam. According to court documents, Hunter, a resident of Houston, was paid $1,500 per week in cash to direct patients to attend the partial hospitalization program at Shifa Texas.

Hunter, in turn, paid each patient $75 per week to attend the program. In an effort to get patients admitted to Shifa Texas, Hunter instructed patients as to the types of symptoms and diagnoses to describe to physicians in order to be admitted to the program.

Hoor Naz Jafri, 54, owned and operated two communities’ mental health centers in Baton Rouge and one in Houston. She was to pay $43.5 million in restitution and serve 8-and-a-half years in federal prison for a Medicare fraud.

The case was investigated by HHS-OIG, the FBI, and the Medicaid Fraud Control Unit of the Louisiana State Attorney General’s Office, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section.

This case is being prosecuted by Trial Attorneys Abigail Taylor and Dustin Davis of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Shubhra Shivpuri of the Middle District of Louisiana.

[...]

UPDATE:

As seen in this report

• The Federal Bureau of Investigation announced that an operator of community health centers in Louisiana and a patient recruiter from Texas have been sent to prison for a Medicare fraud scheme that totaled to $258 million in inappropriate claims. 

• Roslyn F. Dogan, the health center operator, both encouraged patients to seek treatment in partial hospitalization programs in full knowledge that they did not need psychiatric care and directed staff to alter records to indicate that patients received care when in fact they did not. James R. Hunter, the recruiter, recruited people who were ineligible for partial hospitalization in exchange for cash payments of $75 per week. 

• Dogan and Hunter are two of 17 total people to be convicted in this case, including psychiatrist Zahid Imran, MD, co-owner of the Louisiana community health centers and the Texas facility.

Dive Insight: 

• Leveraging partial hospitalization programs for Medicare fraud seems to be an emerging trend. Last month, four individuals—former president of Riverside Hospital, Earnest Gibson III, his son, Earnest Gibson IV, Regina Askew and Robert Crane—were convicted for taking $158 million in Medicare funds for psychiatric care that was not rendered at the Texas institution. And according to Assistant US Attorney Ted Radway, there has been an "explosion of fraud in community-based treatments."

The British Parliament's Health Select Commitee has issued a damning report on the alarming failings in children’s mental health services

You can read the report online here and download a PDF of the 179 page report as well.

As reported in the Mirror:

Thousands of mentally unwell children are being failed because of “serious and deeply ingrained problems” in the provision of care, MPs warn today.

In a damning 117-page report, the Health Select Committee lays bare the alarming failings in children’s mental health services.

The official House of Commons probe was prompted in part by a series of campaigning articles in the Mirror, which submitted evidence to the committee’s inquiry.

Its report warns how “in many areas early intervention services are being cut or are suffering from insecure or short term funding”.

[...]

Earlier this year the Mirror uncovered how 4,391 children aged 10 or under had received treatment for stress, anxiety or depression since 2009 at two of the biggest NHS mental health trusts.

But Tory MP Dr Sarah Wollaston said it was a “disgrace” that data had not been collected centrally for over a decade.

She highlighted how the cost of a child’s in-patient bed in a mental health ward costs £25,000 a month. If that sort of cash had been spent on early schemes such as drop-in services it could have helped avoid the need for dozens of children to be admitted to hospital, she said.

While it is praise worthy that they want to do something for the children, they seem to be overlooking the inherent failure of psychiatry itself. No wonder the system is in such deplorable condition.

An Australian hospital offered a job in its psychiatric emergency unit to a doctor who had been deregistered over his lengthy drug addiction and ‘‘bizarre’’ treatments.

As seen in this report from the Newcastle Herald out of Australia

While addicted to psychostimulants, Dr Kim Street had painted the walls of his surgery black, was unable to pay bills, and exposed patients to experimental drug therapies without their knowledge. He prescribed the wrong drugs to pregnant women and elderly patients, as well as patients with a history of psychosis, post-traumatic stress disorder (PTSD), erratic criminal behaviour, gambling addictions, major depression and social phobias. Dr Street, who moved to Swansea in 2000, faked patient prescriptions and pretended to pick up medications on their behalf. In September the Mater hospital offered him work in its psychiatric emergency unit under the supervision of Hunter New England Mental Health medical services director Dr Marcia Fogarty. That was despite Dr Street’s lack of acute care experience and the fact he had been heavily addicted to prescription drugs between 2002 and 2012.

Note: Deregistered = He lost his license to practice Much more about this train wreck at the link

A Natural Fix for A.D.H.D.

The New York Times has an article by By Richard A. Friedman on A.D.H.D

Here's a brief Snippet

My patient “treated” his A.D.H.D simply by changing the conditions of his work environment from one that was highly routine to one that was varied and unpredictable. All of a sudden, his greatest liabilities — his impatience, short attention span and restlessness — became assets. And this, I think, gets to the heart of what is happening in A.D.H.D.

Consider that humans evolved over millions of years as nomadic hunter-gatherers. It was not until we invented agriculture, about 10,000 years ago, that we settled down and started living more sedentary — and boring — lives. As hunters, we had to adapt to an ever-changing environment where the dangers were as unpredictable as our next meal. In such a context, having a rapidly shifting but intense attention span and a taste for novelty would have proved highly advantageous in locating and securing rewards — like a mate and a nice chunk of mastodon. In short, having the profile of what we now call A.D.H.D. would have made you a Paleolithic success story.

In fact, there is modern evidence to support this hypothesis. There is a tribe in Kenya called the Ariaal, who were traditionally nomadic animal herders. More recently, a subgroup split off and settled in one location, where they practice agriculture. Dan T. A. Eisenberg, an anthropologist at the University of Washington, examined the frequency of a genetic variant of the dopamine type-four receptor called DRD4 7R in the nomadic and settler groups of the Ariaal. This genetic variant makes the dopamine receptor less responsive than normal and is specifically linked with A.D.H.D. Dr. Eisenberg discovered that the nomadic men who had the DRD4 7R variant were better nourished than the nomadic men who lacked it. Strikingly, the reverse was true for the Ariaal who had settled: Those with this genetic variant were significantly more underweight than those without it.

So if you are nomadic, having a gene that promotes A.D.H.D.-like behavior is clearly advantageous (you are better nourished), but the same trait is a disadvantage if you live in a settled context. It’s not hard to see why. Nomadic Ariaal, with short attention spans and novelty-seeking tendencies, are probably going to have an easier time making the most of a dynamic environment, including getting more to eat. But this same brief attention span would not be very useful among the settled, who have to focus on activities that call for sustained focus, like going to school, growing crops and selling goods.

In other words, it's not a disease at all, but a part of the normal spectrum of the human condition.

Staff on psychiatric wards at risk for violent abuse

As seen in this news item

In the Italian psychiatric facilities, there are more than 1,000 cases a year of violence against health care workers. And in twenty years 8 of them were killed. The victims are usually doctors and nurses that, in this country, take care of over 3.5 million patients. Very often they are drug addicts who do not have a specific mental disorder, but access these health services because they are the only ones available to the public. This is the complaint of the SIP (Italian Society of Psychiatry), launched for the First National Day of health and safety of the health workers to the care of psychiatric patients, which takes place today in Bari.

Given the admitted inability of Psychiatry to provide any cures, and with this evidence that they cannot rehabilitate people, why would anyone want to join a failed profession?

Leading Harvard Psychologist criticizes efforts to replicate experimental findings: "unsuccessful experiments have no meaningful scientific value"

As seen in this paper

On the emptiness of failed replications - by Jason Mitchell, Harvard University

Of note is the section entitled "Why the replication efforts are not science". This has raised the ire of a number of people because a fundamental of modern Science is the reproducible result.  If you can't reproduce it or replicate it, then the original results are in question.

The inability to reproduce scientific results has been a major problem for the social science in the past few years. Here we have someone whining that we should take them seriously even if someone else can't reproduce the research that the "conducted.

The paper was written by Jason P. Mitchell, principal investigator of Harvard University's Social Cognitive and Affective Neuroscience Laboratory. Mitchell received his B.A. and M.S. degrees from Yale University in 1997 and his Ph.D. from Harvard University in 2003. He is currently an assistant professor in Harvard’s Department of Psychology. He was the John L. Loeb Associate Professor of the Social Sciences at Harvard
The Less Wrong community blog notes:

This is why we can't have social science. Not because the subject is not amenable to the scientific method -- it obviously is. People are conducting controlled experiments and other people are attempting to replicate the results. So far, so good. Rather, the problem is that at least one celebrated authority in the field hates that, and would prefer much, much more deference to authority.

Advocacy group for mentally ill denied access to Franklin County jail

As reported by the Tri-City Herald in Wisconsin (more information at the link)

Franklin County corrections officers did not allow an attorney with an advocacy group for the mentally ill inside the county jail on a visit this week.

Disability Rights Washington received a complaint about the conditions for two inmates in the jail and sent an attorney to check the facility Oct. 28, said David Carlson, the Seattle group’s director of legal advocacy. Federal law allows the private agency to visit any place that houses people with mental illness, including jails, psychiatric hospitals, homeless shelters and nursing homes.

But attorney Anna Guy was not allowed inside the cell pods and, instead, had to speak with inmates in the visitation area, Guy said in a Friday letter to county Deputy Prosecutor Tim Dickerson.

Officers told Guy when she arrived that jail Capt. Rick Long would not be able to speak with her because he was busy and she arrived at 10 a.m. for her scheduled 9:30 a.m. visit, she said. They told her to instead wait for Dickerson.

The agency likes to see inside the jail to get a better idea what conditions the inmates are living in, Carlson said.

Franklin County Sheriff Richard Lathim said Guy told the jail by email late Monday afternoon that she would be visiting Tuesday, giving jail staff little time to prepare. Tuesdays usually are busy because of inmate traffic to and from court. Sheriff’s officials referred the lawyer to the prosecutor’s office because the sheriff’s office didn’t understand what she was looking for.

“Basically, they were inconsiderate and rude and very unclear with what they wanted,” Lathim said.

Lathim questions the authority the group has to visit the jail.

“I’m sure the federal law doesn’t say you can show up at the busiest time and do what you want,” he said.

Disability Rights Washington sent an informal notice that it was coming because it has worked with the jail before, and it is not required to give any notice, Carlson said. The group received an email back Tuesday morning from Long saying the visit was OK.

“We don’t write really long lawyer letters every time we go someplace, especially if they know us,” he said.

Dickerson told Guy that he was unfamiliar with Disability Rights Washington, Guy said in her letter. He then told her that low staffing levels at the jail and pending litigation could affect the visit.

“I explained that pending litigation does not preclude DRW from accessing your facilities and inmates,” Guy said. “I also explained that DRW’s authority grants it unaccompanied access to facilities.”

An unrelated lawsuit, brought by Columbia Legal Services of Seattle, claims mentally ill inmates are subjected to inhumane and barbaric practices at the jail.

Dickerson continued to deny Guy access to the inmate holding and medical areas, Guy said. But he allowed her to see inmates in the visitation area.

You can find the Disability Rights Washington website here

Local Doctors Accused of Abusing Drugs, Alcohol and Over-Prescribing in Some Cases Killing Patients. California Prop 46 calls for Drug Testing for Doctors

As seen in this report

Local Doctors Accused of Abusing Drugs, Alcohol and Over-Prescribing in Some Cases Killing Patients

Of particular intere is California's propostion 46

Proposition 46 calls for random drug and alcohol testing of California doctors who work at hospitals or have hospital admitting privileges. It would also require doctors to submit to substance abuse testing if a patient under their care suffers medical harm.

Click here to see the complete voters guide on Proposition 46 from California’s Secretary of State Office.

Of course doctors are opposed to this.

there is a video report as well


What do you think?

Psychiatrist Howard Mahler Facing Rape Charges; He Also Saw Patients and Then Had Other Doctor Write The Prescriptions, according to DA

Just in time for Halloween we have this report from the Port Washington Patch

A Long Beach psychiatrist conspired with an ex-doctor from Sands Point to sell prescriptions for Adderall and Xanax, according to the Nassau County District Attorney’s office.

Howard Mahler, 62, of Long Beach, was charged with five counts of criminal sale of a prescription for a controlled substance and fourth-degree conspiracy. He faces a maximum of five to 15 years in prison if convicted, the DA said.

Mahler is accused of selling prescriptions for addictive drugs to patients of former psychiatrist Marshall Hubsher, 64, of Sands Point, the DA said.

Hubsher was charged with third-degree rape in 2012 for allegedly having sex with a patient, the DA said. Despite having his license revoked, Hubsher kept meeting with patients in exchange for cash, the DA said. Hubsher would reportedly meet with patients in office hallways before they would go in to meet with Mahler, who wrote prescriptions based on information given to Hubsher, officials said.

Hubsher is charged with five counts of unauthorized practice of a profession and fourth-degree conspiracy, the DA said. He faces up to four years in prison if convicted.

In one instance, an undercover detective posed as a patient and confessed to Hubsher that he wanted higher doses of Adderall so he could sell them and buy Oxycodone, the DA said.

Long Island division DEA officials arrested Hubsher and Mahler in Hubsher’s office Wednesday, officials said.

Both Mahler and Hubsher are due back in court Nov. 3. Hubsher will also return to court Dec. 1 on the previous rape charge.

Related: Sands Point Psychiatrist Faces Rape Charges

Patient Files Lawsuit After Photo of Suicide Attempt Posted Online

As seen in this report

Last week, a Los Angeles County-University of Southern California Medical Center patient filed a lawsuit after a photograph of her failed suicide attempt was taken by a nurse and eventually posted to a "shock" website, Reuters reports.

In 2012, the patient tried to commit suicide by sticking pencils through her eyes. She was taken from the facility where the incident occurred and treated at Los Angeles County-USC Medical Center. An unidentified nurse took a photo of the patient's injuries and shared it. A person who received the picture posted it to an undisclosed website, where it has since received more than 192,000 views, according to the lawsuit.

The patient was left blind as a result of the injury. She later received psychiatric treatment and got "her life back on track," but she became depressed when the photograph was widely viewed online, according to the lawsuit.

Before the lawsuit was filed, Douglas Johnson -- the patient's lawyer -- asked the medical center and county officials, who administer the hospital, to have the picture removed from the Internet. According to Johnson, the officials could make such a request by exercising their copyright of the photo because it was taken in their facility.

Reuters reports

A nurse at a Los Angeles hospital took a photo of a woman who gouged out her own eyes with pencils, and the patient sued the hospital and its administrators after the picture went viral on the Internet, her attorney said on Wednesday.

[...]

The as-yet unidentified nurse took the photograph of the patient with the "intact pencils sticking out of her eyes," then shared the unauthorized picture with another person, who passed the image to Joshua Shivers, the lawsuit said.

Shivers, in turn, used his mother's computer to post the image to a "shock" website, the suit stated, adding that the photo has since been viewed more than 192,000 times. The specific website to which it was posted was not disclosed.

"Everybody knows that as soon as someone gets their hands on something like this, it goes viral and the harm is done," said Douglas, who specializes in privacy cases.

Much more at the Reuters' link

Here we have a nurse violating the patient's privacy for her own entertainment. Disgusting.