16 separate hospitals and their respective corporate parents have agreed to collectively pay $15.69 million related to fraudulent billing of psych services

Press Release From the US Department of Justice

Sixteen Hospitals to Pay $15.69 Million to Resolve False Claims Act Allegations Involving Medically Unnecessary Psychotherapy Services

The Justice Department announced today that 16 separate hospitals and their respective corporate parents have agreed to collectively pay $15.69 million to resolve False Claims Act allegations that the providers sought and received reimbursement from Medicare for services that were not medically reasonable or necessary, the U.S. Department of Justice announced today. 

“Hospitals that participate in the Medicare program must ensure that the services they provide and bill for are based on the medical needs of patients rather than the desire to maximize profits,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.  “The Department of Justice is committed to ensuring that those who seek to abuse the Medicare program will be held accountable for their actions.”

This case concerns claims to Medicare for Intensive Outpatient Psychotherapy (IOP) services.  IOP services represent a continuation of ambulatory psychiatric services and provide active treatment to individuals with mental disorders using a variety of treatment methods.  Medicare will pay for an appropriate course of IOP treatment provided a number of specific requirements are met including, most notably, that the services in question are reasonable and necessary for the diagnosis and treatment of the patient’s condition.

These settlements resolve allegations that, beginning as early as 2005 and in some cases continuing into 2013, the hospitals knowingly submitted claims for IOP services that did not qualify for Medicare reimbursement because: the patient’s condition did not qualify for IOP; the patient’s treatments were not provided pursuant to an individualized treatment plan designed to help the patient address specific mental health needs and reach achievable goals; the patient’s progress was not being adequately tracked or documented; the patient received an inappropriate level of treatment; and/or the therapy provided was primarily recreational or diversional in nature, and not therapeutic.  The IOP services in question were typically performed on the providers’ behalf by Allegiance Health Management (Allegiance), a post-acute healthcare management company based in Shreveport, Louisiana, but billed to Medicare by the providers.

The providers who have reached agreements to resolve these allegations with the United States include:

• Health Management Associates Inc. (HMA), and the following 14 hospitals formerly owned and operated by HMA: Central Mississippi Medical Center in Mississippi, Crossgate River Oaks in Mississippi, Dallas Regional Medical Center in Texas, Davis Regional Medical Center in North Carolina, East Georgia Regional Medical Center in Georgia, Gilmore Regional Medical Center in Mississippi, Lake Norman Regional Medical Center in North Carolina, Lehigh Regional Medical Center in Florida, Medical Center of Southeastern Oklahoma in Oklahoma, Natchez Community Hospital in Mississippi, Northwest Mississippi Regional Medical Center in Mississippi, Santa Rosa Medical Center in Florida, Southwest Regional Medical Center in Arkansas, and Summit Medical Center in Arkansas, which agreed to collectively pay $15 million;

• Community Health Systems and its subsidiary Wesley Medical Center in Mississippi, which agreed to pay $210,000; and

• North Texas Medical Center in Texas, which agreed to pay $480,000.

In October 2013, the United States resolved similar allegations with LifePoint Hospitals Inc. and two of its subsidiaries, PHC-Minden L.P., doing business as Minden Medical Center, and PHC-Cleveland Inc., doing business as Bolivar Medical Center, which collectively paid $4,672,469.80.

“This case demonstrates that the U.S. Attorney’s Office for the Eastern District of Arkansas will aggressively pursue civil health care fraud cases, where the integrity of the Medicare system has been undermined,” said U.S. Attorney Christopher R. Thyer of the Eastern District of Arkansas.  “Medical care providers who abuse Medicare hurt all taxpayers, and today’s announcement highlights our commitment to protecting our national health care system, as well as the Arkansans who depend on it.”

“Our agency is dedicated to investigating health care fraud schemes such as this, which divert scarce taxpayer funds meant to provide for legitimate patient care, including services for the often underserved mentally ill population,” said Special Agent in Charge Mike Fields of U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG).

The allegations resolved by today’s settlements arose from a lawsuit filed under the False Claims Act.  The act allows private individuals known as “relators” to sue on behalf of the United States and to share in the proceeds of any settlement or judgment that may result.  The relator in this case will receive $2,667,300. 

These settlements were the result of a coordinated effort by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Eastern District of Arkansas and HHS’ Office of Audit Statistics and OIG.

These settlements illustrate the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $24 billion through False Claims Act cases, with more than $15.3 billion of that amount recovered in cases involving fraud against federal health care programs.

The claims settled by these agreements are allegations only, and there has been no determination of liability. 

Chicago's West Side Hartgrove Psychiatric Hospital focus of widening Justice Department probe

Highlight/Lowlights from this Chicago Tribune article

The Justice Department's criminal probe into Universal Health Services has entered a new and more serious phase, focusing on potential wrongdoing by the corporation as a whole and not just its individual facilities.

Universal, the nation's largest behavioral health firm, had previously disclosed a federal investigation into 18 of its 190 psychiatric centers across the country.

But in late March, the department's Criminal Frauds Section notified the company that "Universal as a corporate entity" is now under scrutiny, according to a regulatory disclosure filed by Universal on Tuesday.

As federal agents examine allegations of fraudulent Medicare and Medicaid billing by the corporate office, they have highlighted one facility in particular, the company disclosure said: Hartgrove Hospital on Chicago's West Side.

[...]

The Justice Department began investigating Universal facilities in Illinois in 2008 after the Tribune documented allegations that juvenile state wards and other youths were sexually assaulted at the firm's west suburban Riveredge psychiatric hospital.

The state Department of Children and Family Services in response commissioned the University of Illinois at Chicago's psychiatry department to examine conditions at Riveredge, Hartgrove and other psychiatric facilities that serve Illinois wards.

In a 2010 report, the UIC experts described an environment of chaos, physical attacks and sexual assaults of young patients at Hartgrove, saying the West Side facility was regularly understaffed and over capacity.

Also part of the expanding federal probe is Universal's Rock River Academy, a 59-bed Rockford resident treatment center that promises intensive, round-the-clock care to female state wards who suffered abuse and neglect, as well as disadvantaged girls with mental health problems.

Jurors to decide fate of South Florida psychiatrist, others in Medicare fraud trial

Highlights from an extended report in the Miami Herald

Barry Kaplowitz was a psychiatrist with a “robotic” signature who signed off on thousands of bogus treatments at a Hollywood psychiatric facility that bilked Medicare for millions — even when he was out of the country, prosecutors say.

“It’s not just any kind of signing; it’s robo-signing,” Justice Department prosecutor Andrew Warren declared during closing arguments at his Miami federal trial.

[...]

On Tuesday, Miami federal jurors resumed deliberating the fate of Kaplowitz, 54, an Aventura psychiatrist who worked part-time as the medical director of Hollywood Pavilion’s outpatient facility, and two other defendants on charges of conspiring to defraud Medicare and related offenses.

[...]

The other defendants are Melvin Hunter, 63, a Broward resident who worked as an admissions supervisor for Hollywood Pavilion’s inpatient facility, and Tiffany Foster, 49, an Alabama resident accused of taking bribes to refer mental health patients.

A fourth defendant, Christopher Gabel, 62, of Davie, the former chief operating officer, pleaded guilty in November to conspiring to commit healthcare fraud and pay kickbacks to patient recruiters. Gabel, who is serving a six-year prison term, testified that Medicare beneficiaries — including drug addicts with disability status — were admitted regardless of whether they qualified for treatment or even saw a doctor.

The latest trial followed the 2013 conviction of Hollywood Pavilion's chief executive officer, Karen Kallen-Zury, of Lighthouse Point, who was found guilty along with three other employees of conspiring to bilk $67 million from Medicare by filing phony claims for mental health services from 2003 to 2012. Medicare was tricked into paying $40 million to Hollywood Pavilion. Of those defendants, Kallen-Zury received the longest sentence: 25 years.

During the six-week trial, prosecutors presented evidence showing that Kaplowitz generated $6.5 million in false claims for Medicare patients who did not need psychiatric treatment, resulting in $3 million in tainted income for Hollywood Pavilion between 2008 and 2011. The psychiatrist was paid $1,250 a month over that period for showing up one day a week to sign charts and other paperwork to justify 2,800 false claims to Medicare, prosecutors said.

[...]

The prosecution of Kaplowitz, Hunter and Foster was the latest crackdown by the Justice Department and U.S. attorney's office against operators of mental-health facilities accused of fleecing the Medicare program.

Three previous major prosecutions led to the convictions of about 100 clinic operators, doctors, therapists and patient recruiters at American Therapeutic, Biscayne Milieu and Health Care Solutions Network in South Florida.

Several of those convicted defendants testified at the latest trial. Among them: Dr. Alan Gumer, a former medical director at the Hollywood Pavilion facility who is serving a 21/2-year sentence in the American Therapeutic case, and Keith Humes, a Hollywood Pavilion patient recruiter who is serving a seven-year prison sentence stemming from another Medicare fraud offense.

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

From a report in the Times Colonist

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

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

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

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

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

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

[...]

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

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

Update: The Prosecution of Psychiatrist Dr. Alan Beitel

We have an update on the prosecution of psychiatrist Allan Beitel. Essentially, the charges were dropped for a number of practical reasons as seen in the article below.

1. He wasn't going to get anymore jail time than what he had already served while waiting for trial, and
2. the victim was moving out of the country, and would not be available to give testimony.

These circumstances are not a clean verdict such as acquittal, and leaves a cloud of suspicion over the doctor's head. This is also not a clean statement of innocence by the prosecutor, although the original charges were a little convoluted. The psychiatrist still faces other criminal charges, according to the report. As reported in The Hamilton Spectator.

Charges of accessing and possessing child pornography against a psychiatrist who formerly practised in Hamilton and Burlington have been stayed by the Crown.

Dr. Allan Beitel, who now practices in Toronto, had been facing the charges since 2003.

The Crown also stayed a charge of possession of stolen property and two counts of failing to comply against Beitel.

The Crown's prosecutor concluded that it was no longer in the public's interest to continue prosecution of the case, according to a spokesperson for Ontario's Ministry of the Attorney General.

"Even if Dr. Beitel had been found guilty of all charges, it was unlikely that he would serve a single additional day in jail beyond the time he had already served in pre-trial custody," the spokes-person indicated.

"Given that completing the trial would have required significant amounts of additional court time and resources, the Crown concluded that it was not in the public interest to continue."

Beitel had spent a number of months in custody last year related to other charges.

A charge of sexual assault against Beitel has also been withdrawn by the Crown after concluding there was no longer a reasonable prospect of conviction.

"The victim was moving out of the country and would not be returning for the trial," the ministry spokesperson indicated.

Beitel is still facing a number of other charges, including perjury, fraud under $5,000, two counts of theft under $5,000 and six counts of fail to comply with a recognizance.

Beitel remains an active member of the College of Physicians and Surgeons of Ontario, with no past disciplinary findings against him.

UPDATE: see also this Blog Post by David Akin

Pennsylvania judges accused of jailing kids for cash

As seen in this report

For years, the juvenile court system in Wilkes-Barre operated like a conveyor belt: Youngsters were brought before judges without a lawyer, given hearings that lasted only a minute or two, and then sent off to juvenile prison for months for minor offenses.

The explanation, prosecutors say, was corruption on the bench.

In one of the most shocking cases of courtroom graft on record, two Pennsylvania judges have been charged with taking millions of dollars in kickbacks to send teenagers to two privately run youth detention centers.

"I've never encountered, and I don't think that we will in our lifetimes, a case where literally thousands of kids' lives were just tossed aside in order for a couple of judges to make some money," said Marsha Levick, an attorney with the Philadelphia-based Juvenile Law Center, which is representing hundreds of youths sentenced in Wilkes-Barre.

Prosecutors say Luzerne County Judges Mark Ciavarella and Michael Conahan took $2.6 million in payoffs to put juvenile offenders in lockups run by PA Child Care LLC and a sister company, Western PA Child Care LLC. The judges were charged on Jan. 26 and removed from the bench by the Pennsylvania Supreme Court shortly afterward.

No company officials have been charged, but the investigation is still going on.

This fits into a larger pattern nation wide of sending kids away for "treatment" whenit is really for profit.

Black Youth, Over-Medicated and Underserved - Part 1

As seen in this report by Charlene Muhammad of FinalCall.Com. While we acknowledge that some news reports from the Black Muslim community can be controversial, there are also many items that are woefully underreported. We are breaking this up into three sections, with the first one posted below today:

The Rev. Fred Shaw, Jr., of the Basic Life Institute in Compton, Calif., has been working with troubled youth and gang-bangers for over a decade. But as he tries to help them turn their lives around, the specter of drugs has surfaced. Not illegal drugs, like crack cocaine or meth, but legal drugs that the activist is concerned with.

He believes psychotropic drugs, like Ritalin, are over-prescribed, and hastily dispensed to control young people, instead of helping them deal with serious emotional and social problems. “We don’t even know the full scope of the impact of these drugs on our youth and people don’t care enough to test whether or not it’s the stimulants that are causing them to shoot and violently kill one another,” he said.

Before working with the Basic Life Institute, the Rev. Shaw co-owned a group home and was stunned by the number of Black youth that were medicated. “African Americans are 16 percent of the nation’s student population but we’re 32 percent of students being drugged, but it’s so entrenched into the system that people have bought into the process wholesale,” he said.

He believes authorities stopped referring clients because he opposed drugging of youth in his group home. The activist also believes mental health drug campaigns are well orchestrated and pushed by pharmaceutical companies. “They fund the psychiatric research, then the psychiatrists develop diagnoses which allows the companies to sell their drugs through them. One hand is washing the other, and they have studied normal adolescent behaviors and made them mental disorders,” Rev. Shaw charged.

Psychotropic drugs are prescribed to treat mental disorders and diseases. That means the same drugs may be used to calm youngsters who are hyper and to stimulate young people who may be depressed.

The most common diagnosis that results in drug treatments is Attention Deficit and Hyperactivity Disorder (ADHD). According to the FDA, ADHD accounts for up to 50 percent of mental health referrals for children and at least 7.5 percent of all school-aged children are affected by ADHD. The National Center for Health Statistics reports that 4.7 million children between 3-17 years of age were diagnosed with ADHD. The percentage of boys was 9.5 percent while girls comprised 5.9 percent.

The fears voiced by Rev. Shaw aren’t new and Black psychologists have raised questions about the impact and long-term effects of drugging Black children diagnosed with Attention Deficit Disorder. Some federal warnings boost their worries.

Last year, the Food and Drug Administration ordered manufacturers of psychotropic drugs to develop patient medication guides to warn of possible cardiovascular risks associated with the drugs. Such drugs, which include Ritalin, Concerta, Adderall and Strattera, are usually given to children diagnosed with ADD or ADHD. Side affects include anxiety or nervousness; headache or dizziness; insomnia; headache, stomach pain, sleeplessness and decreased appetite.

Early last year, the FDA also indicated that ADHD medicines showed a slight risk (about 1 per 1,000) for drug-related psychiatric adverse events, including hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems.

The Centers for Disease Control lists symptoms of ADHD as often fidgeting with hands or feet; squirming in seat; running or climbing when inappropriate; feeling restless; often on the go and talks excessively; and often acting as if driven by a motor.

According to Dr. Ronald Beavers, a psychologist with the Positive Imagery Foundation in South Los Angeles, Black children are disproportionately represented because their needs are greater.

“Our children are locked more into the system and when you look at the statistics and those in foster care and up for adoption, and see what ethnic group is overrepresented, question marks should be coming up because it’s African Americans. Eighty percent of adoptions and 80 percent of foster care are Black children,” Dr. Beavers told The Final Call.

Alternatives to drugs, like group counseling, life skills and culturally competent parenting education, are usually counted out because they cost time and money, he added.

“The ultimate alternative for Blacks is learning how to live,” Dr. Beavers said.

An employee with the Los Angeles Department of Children and Family Services told The Final Call, the department tracks foster care children who are taking psychotropic drugs, but the numbers are not easy to get. Even high-ranking employees find it difficult to get the actual facts about the drugging of children because the numbers are an embarrassment to the department, said the employee, who has a background in social work. The employee asked to remain anonymous.

Normal man held for 55 years in a mental institution. He was not ill..

We came across this case of a person held in a mental hospital for 55 years despite no mental illness.

Can you be held for 55 years without any charge?

Yes, if you are in Sri Lanka. Last Thursday, eighty three year old Thantriye Singho was released from police custody after 55 years. He was arrested in 1953 and all this time he was never charged with any crime.

Why was he arrested in the first place in a time so long ago that none of us can even remember? He was caught carrying a sword in a suburb near Sri Lankan capital Colomo. It is not clear if possession of sword was even a crime at that time. Soon after his arrest, the court sent him to a government hospital for psychological evaluation and treatment.

He was declared mentally healthy and transferred to regular unit of the hospital. But he spent next 55 years of his life in that hospital without the authority bringing any change against him.

A human rights group uncovered his case while doing work on mental patients. They informed the man’s relatives and got a court order for his released.

It is not the fist time this happened in Sri Lanka. Only few months ago another man was released after spending 50 years in custody without any charge. By the time he got out he was 80.

Who Does Your Doctor Really Work For?

In a sidelight from another medical field, TIME Magazine has an interesting article regarding the fallout from a US DOJ investigation into kickbacks in the filed of Orthopedics. We note that the Psychiatric field is probably also great fodder for this sort of thing. But the DOJ is probably just getting warmed up ....

The past year has been a tough one for the business of orthopedics, one in which it has taken a hard, public slap from the U.S. Department of Justice (DOJ).

The DOJ, you see, has discovered the "relationships" that so many orthopedic companies have established with orthopedic surgeons. Companies give money to doctors to test products, to help design or tout products and sometimes just to use a particular product (as in kickback). Orthopedists are hardly the only doctors paid by medical companies, but when the sheer amount of money being given to orthopedists came out of the shade into the sharp San Francisco sunshine last week, it did make quite a few of us blink.

The DOJ's slap was felt acutely by everyone at the convention. No more free dinners, shoulder bags, flashlights and pens. Way fewer models in leotards draped across operating tables and traction equipment. A new ruling requires every research presentation to begin with full disclosure of all monetary relationships the speaker has with any company. Every single fully trained doctor I heard speak was getting paid by a company; many of the bigger-name doctors were getting paid by three or four. How much money was still the subject of gossip — the exact amount is not required to be broadcast in these podium confessionals. The DOJ has, however, ordered companies to list the doctors in their employ, as well as the amounts paid them, on their websites. Judging by those figures, it adds up to plenty. And it got our attention at AAOS. Some doctors thought it immoral; others lamented the doubt it cast on the integrity of research. But I think most just wanted in.

Is the U.S. Supreme Court Poised to Strip Consumers of Right to Sue over Deadly Pharmaceuticals?

As reported here, regarding the case Warner-Lambert Co. v. Kent:

In arguments and discussion for Warner-Lambert Co. v. Kent heard today, Justices are proposing that consumers should not be able to sue pharmaceutical companies for damages from side effects because some people might be helped by those same drugs. Forget all the technical legalities -- this argument is absurd from the outset. Here's why:

If Ford makes a defective car with a poorly-designed gasoline tank that explodes and kills someone, that person's family has a right to sue Ford, correct? But the U.S. Supreme Court is now effectively arguing that Ford should be granted immunity to all lawsuits because its cars provide benefits to other drivers.

In other words, the fact that Ford cars don't kill some consumers somehow makes up for the ones killed by those defective cars. (In this case, Ford is just an example. There is no pending legislation against Ford that involves the U.S. Supreme Court.)

That argument is absurd. If put in place, it would mean that individuals no longer have the right to sue companies for defective products, and the very definition of "harm" is no longer measured on an individual basis but rather by some sort of yet-unstated collective scorekeeping that says no company can be sued if its products provide benefits to somebody.

Of course, this is all being selectively applied only to the pharmaceutical industry at the moment, but if this line of thinking is allowed to continue, it could very quickly lead to blanket immunity for virtually all corporations against any consumer lawsuits. After all, the argument being made to protect Big Pharma is that even though drugs kill lots of people, the fact that they help some people who aren't killed outweighs the liability from the dead people. Should this also apply to automobiles? Fireworks? Roller coasters? At what point does the U.S. Supreme Court think corporations should actually be held liable for the harm caused by their products?

Irish Mental health tribunals have cost over €10 million to date

An interesting story, but what is utterly missed is the point that this is the cost in trying to establish at least some justice in the Irish system of involuntary commitment to mental hospitals. The tone is slightly weird, like this is some unwanted expense. From the Irish Medical News

Over €10 million has been spent on mental health tribunals since they were first established in 2006, it has emerged.

In response to a recent Parliamentary Question, Minister for State at the Department of Health and Children, Dr Jimmy Devins stated that €1,001,174 was spent in 2006 and €9,008,051 was spent in 2007 on tribunals.

The Mental Health Comm­ission did not give a further breakdown of the figures when requested by IMN.

A total of 2,423 tribunals were held during this period, meaning that the average cost of each tribunal is approximately €4,130.

The figures do not include a number of outstanding attendance fees, which have yet to be submitted by mental health tribunal panel members to the Mental Health Commission or the overheads associated with the administration of the mental health tribunals by the Commission, according to Minister Devins. The costs of the tribunals are met from the budget of the Mental Health Commission.

Consultant psychiatrist Prof Patricia Casey has branded the figures as “extraordinary”.

She told IMN that it was of the utmost importance that the Mental Health Commission provide a detailed breakdown of the figures given the costs involved. In particular, Prof Casey said in the interests of transparency and accountability it should be reported how much is being spent on solicitors fees.

Out of the 2,248 hearings held in 2007, 256 cases were revoked at hearing.

Australian Judge who spoke out against Ritalin kids ordered to shut up

This has the smell of political corruption in the Australian legal system. Report from the Daily Telegraph

The judge who accused doctors of creating a generation of Ritalin kids who become criminals has been gagged in an extraordinary move by the state's Judicial Commission.

An ADHD support group which supports the use of drugs like Ritalin complained to the commission that Judge Paul Conlon had got it wrong, The Daily Telegraph has learned.

Judge Conlon criticised the over-diagnosis of ADHD, the over-use of medication and its effect on children.

Instead of dismissing the complaint, as it does in 75 per cent of cases, the commission referred it to Judge Conlon's boss, District Court Chief Judge Reg Blanch. In such cases, the chief judge is expected to counsel the judge or "make administrative arrangements within his or her court" to make sure it doesn't happen again.

Judge Conlon, a former Crown prosecutor, sparked fresh controversy about the use of Ritalin when he made his comments last year during the sentencing of a 20-year-old man who was prescribed the powerful stimulant at the age of six.

Judge Conlon, who jailed the man for 15 months for assault and an act of indecency, was told by a psychiatrist the man had become addicted to methamphetamine because of his Ritalin use.

At the time, the judge said he had huge concerns because of the "amazing tide" of cases coming before him involving people prescribed Ritalin as children who went on to commit violent crimes.

His remarks led to a review of the treatment of ADHD in NSW, which earlier this month reported that it had found no overprescribing of drugs.

However, sources say many doctors refused to co-operate with the study, which had no public input.

Three members of the committee have also served as expert advisers to drug companies, including Novartis, which produces Ritalin. The doctors all declared no conflict of interest.

At the same time, a prominent Sydney psychiatrist, Professor Joseph Rey, wrote in the Medical Journal of Australia that doctors should review their patients' need for the medications.

Psychiatrist loses appeal over sex crimes

A report from the Washington Poston the final failed appeal of a psychiatrist caught doing the wrong thing. Part of a much larger article.

The hearing was entering its 10th hour Thursday night when Arlington County psychiatrist Martin H. Stein learned that his 40-year career as a practicing physician was effectively over.

The Virginia Board of Medicine denied Stein's petition to reinstate the license he surrendered six years ago for his treatment of 10 patients, among them a 4-year-old whose legs he bound with duct tape.

The three-member panel found that Stein had harmed 17 other patients by over-prescribing sometimes dangerous combinations of drugs, diagnosing nonexistent conditions and engaging in unethical behavior with female patients.

Stein, 67, who declared personal bankruptcy five years ago and has been sued more than 15 times since 1995, may reapply or appeal. But both are expensive, time-consuming processes with virtually no chance of success.

Links to earlier Stories

• From the Archives: Va. Doctor's Misconduct Left Trail of Broken Lives
• From the Archives: A Broken Marriage And a 'Life Destroyed'

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.

Child Psychistrist to be sued over faulty evidence, Disgraced pediatrician investigated in 'Child Experiment" case.

The impulse for human experimentation is not restricted to psychiatrists. Here we have a case from Britain involving a pediatrician. We also note that a child psychiatrist is being sued for giving false evidence in the matter. From the IC Wales website

A banned paediatrician whose evidence helped convict Sion Jenkins will next week face an investigation into allegations that he carried out secret experiments on children. [Ed. note - Sion Jenkins was later found fully innocent]

Professor David Southall gave evidence at the former deputy headmaster’s trial nine years ago in which he was found guilty of murdering 13-year-old foster daughter Billie-Jo in 1998.

Mr Jenkins, 50, whose parents live in Aberystwyth, was acquitted of the crime in 2005 after spending six years in jail. He was retried twice but a jury failed to reach a verdict on both occasions.

Next Monday, Prof Southall faces a full General Medical Council probe into experiments he is alleged to have carried out on children.

The month-long investigation will inquire into allegations that Prof Southall, who denies any wrongdoing, acted in a way which was inappropriate and added to the distress of a bereaved person. He is also accused of abusing his professional position in relation to a report he was instructed to prepare by a local authority in relation to the care proceedings of a child.

It is further alleged that Prof Southall kept secret medical records on children.

In the 1980s and 1990s, under the aegis of Dr Southall, thousands of sick children were given breathing tests – called ‘sleep studies’.

The experiments, authorised by hospital ethics committees, were carried out despite the doubts of worried parents.

It is alleged that some of the tiny babies were forced to breathe poisonous gases and deprived of oxygen. The results of these tests were then said to have been stored by the paediatrician in 4,500 files.

The Attorney General now wants to see the files to see if they were produced at court hearings in which parents were accused of child abuse.

Last November, one Swansea mother told a GMC hearing that the paediatrician, who was accused of tampering with her child’s hospital records, treated her son like a ‘lab rat’.

The GMC probe comes as South Wales Police investigate an allegation of assault concerning Prof Southall involving a child being treated within the University Hospital Wales in the Heath, Cardiff, in 1991.

Sources close to Mr Jenkins say the former deputy head will be watching next week’s probe with interest after making an independent complaint against Prof Southall to the GMC.

Mr Jenkins has also lodged a formal complaint against Dr Arnon Bentovim, a child psychiatrist whose evidence at his original trial in 1998 helped to secure his conviction.

Earlier this year Mr Jenkins said: “I have decided to take this action because I believe that Prof Southall and Dr Bentovim must answer for their false evidence.

“Together, these two men paved the way for the destruction of my family and my wrongful conviction, and also allowed the murderer of Billie-Jo to remain at liberty.”

At the time Mr Jenkins’ solicitor Frances Swaine said: “It is absolutely essential that any doctor who provides evidence in the prosecution of a murder suspect should do so with the highest possible regard for his professional conduct.

“Failure to do so – as we have seen in a number of cases in recent years – may lead directly to serious injustice”.

Prof Southall was banned from child-protection work by the GMC in 2004 for his ‘high-handed intervention’ in the case of solicitor Sally Clark, who was jailed in 1999 for murdering her two baby sons.

He accused Mrs Clark’s husband Stephen of killing the children after watching a Channel 4 Dispatches show about the case. Mrs Clark was freed on appeal in 2003 and died in March this year. In July, Prof Southall’s ban was extended for a year by a medical fitness to practice panel.

Psychiatrist Loses Criminal Appeal

As seen in this report from the Capitol News Service

A Maryland court Wednesday upheld disciplinary action against the psychiatrist who leaked details about the sexual habits and mental health of convicted spy Robert Hanssen in 2001.

A three-judge panel of the Maryland Court of Special Appeals upheld lower court rulings against Alen J. Salerian, who had been hired by defense attorneys to evaluate Hanssen, a former FBI agent arrested for giving highly classified information to Russia.

The two met over the course of a week in April 2001, during which Hanssen admitted he had a "long history of sexual betrayal and exploitation" of his wife -- a fact that Salerian later shared with Hanssen's wife.

Court documents said Salerian was warned repeatedly by Hanssen's attorney, Plato Cacheris, not to disclose any details of his conversations with the former FBI agent. Salerian, along with most others involved in the case, had also signed a letter from the U.S. Attorney General promising not to disclose information about Hanssen due to "national security interests" involved.

In May 2001, within a week after telling Hanssen's wife about the sexual betrayals, Salerian was fired by Cacheris. Salerian also received a letter from Hanssen forbidding him from discussing their meetings with anyone other than defense attorneys, including family members and "certainly with anyone outside the family."

But in the following weeks, Salerian was quoted in numerous media outlets discussing Hanssen's mental state.

In a June 2001 CBS report, Salerian claimed that he had disclosed the information with Hanssen's permission. Salerian, who believed the FBI, the church and the medical system had failed Hanssen, said it was "a situation where there was life and death involved and I had to make a call as a physician to say what I think is right."

In a disciplinary hearing against Salerian, Hanssen testified via telephone that he had agreed to let Salerian tell his wife about the sexual exploits because Salerian convinced him that the media were about to publish it.

Hanssen pleaded guilty to espionage in July 2001 and is serving life in federal prison. The 2007 film "Breach" was based on his arrest.

Hanssen's attorneys and wife filed a complaint against Salerian in September 2001 with the Maryland State Board of Physicians, charging he disclosed confidential information. That same month, Salerian's license to practice medicine in Maryland expired.

He applied for reinstatement of his license in September 2002, only to be told the board was charging him with immoral and unprofessional conduct and violating attorney-client and physician-patient privilege. He attempted to withdraw his application in July 2003, but was told he could not do so while charges were pending.

An administrative law judge initially recommended that Salerian be fined $20,000, have his license revoked and be barred from applying for reinstatement for up to three years.

In January 2005, the board decided instead that Salerian be fined $5,000 and be placed on probation for two years, which would not end until he completed an ethics course.

Salerian challenged the action, but it was upheld by the Montgomery County Circuit Court. He raised 10 issues in his appeal to the Maryland Court of Special Appeals, which rejected all 10 Wednesday.

Messages left on his voicemail Wednesday at the Washington Center for Psychiatry were not returned. A woman who answered the phone at the address listed for Salerian in the state physicians board's records said he had not lived there for six years.

Cacheris called Wednesday's ruling accurate and said he agreed with the penalties against Salerian.

His lobotomy, his recovery, in his words

A review of an important book from the San Francisco Chronicle

Until he was 5, Howard Dully was a happy child. That was the year his mother, June, died of cancer. June was "loving and indulgent," Dully writes, so devoted that his father once said, "I could've dropped dead and it wouldn't have made a bit of difference. She had you."

After his mother's death, neighbors started sewing and cooking, doing laundry for the Dullys. One of them, Lucille "Lou" Cox, became his stepmother two years later. Rigid and punitive, Lou hated Howard. When he was 12, she arranged for the boy to have a transorbital lobotomy.

The surgeon, Dr. Walter Freeman, did the procedure at Doctors General Hospital in San Jose. After sedating Howard with four jolts of electroshock, Freeman inserted two skewer-like steel knives into his skull, entering through the inside of the right and left eye sockets.

"(He) swirled them around," Dully writes, "until he felt he had scrambled things up enough." The lobotomy took 10 minutes to perform. The charge was $200.

This is the story that Dully, a 58-year-old San Jose bus driver, tells in his memoir, "My Lobotomy" ($24.95, Crown Publishers). It's a gruesome but compulsively readable tale, ultimately redemptive. Unlike most lobotomy patients - some became vegetables, 15 percent died - Dully was relatively unscathed.

"The biggest impact it made on me was my self-esteem," Dully says during a conversation in Jimmy's, a San Jose coffee shop with early-'60s decor. "You know, they changed me. They rearranged me. 'Am I me any more? Am I really crazy and don't know it?' These things all go through your mind."

Dully is hardly the picture of victimhood. Six-foot-seven, 330 pounds, he's a bear of a man with enormous hands, a voice like a cello and the visage of a grizzled biker. Until last year, he wore his mustache super-long and droopy, like Yosemite Sam, and then decided "I was hiding behind it."

No one would want to mess with this guy, but when you sit down with Dully you find a gentle, vulnerable man who speaks easily of emotional hurt. Traces of sadness are embedded in his face. His mood is subdued - or at least leveled - by the Prozac he's taken for four years.

What's surprising is Dully's lack of bitterness. Despite the lobotomy, despite the subsequent years when he was bounced from foster home to juvenile hall to mental institution - he says "there's no point" in being angry.

"I've worked through all that. The only person it's gonna hurt is me. My biggest question is 'Why?' Why would an adult play the game to the extent it was played? ... I'm not going to say I was walking on water and here came the evil stepmother who just had things poked into the back of my head. But I don't feel I did anything to deserve a lobotomy."

At 12, Dully was already 6 feet tall - a "hellious" kid, in his words. He lied and shoplifted on occasion. He smoked cigarettes. Hated homework. Because his dad worked three jobs and was never home, his stepmom meted out the discipline. "Lou was a fairly small woman and it finally got to the point where she'd spank me and I'd laugh. I think that scared her."

In "My Lobotomy," Dully and co-writer Charles Fleming describe how Lou consulted six psychiatrists in her search for a solution, and was told by four of them that she was the problem and not Howard. Finally, she found Freeman and convinced him that her stepson was a candidate for lobotomy.

Freeman, subject of a recent book, "The Lobotomist" by Jack El-Hai, didn't need to be lobbied or prodded. A psychiatrist and neurologist, he didn't invent the lobotomy but popularized and promoted it. Full of hubris, he touted the procedure's benefits at medical conventions, behaving, his partner James Watt said, "like a barker at a carnival."

When patients suffered permanent brain damage, Freeman was unfazed. "Maybe it will be shown," he said, "that a mentally ill patient can think more clearly and constructively with less brain in actual operation."

Given the brutality and imprecision of the lobotomy procedure, Dully is luckier than most survivors. He believes his tear ducts were damaged by the lobotomy and attributes his sinus problems to the procedure. His thinking processes, he says, "seem to go off in different directions to reach conclusions, instead of focusing down one path."

More than anything, he feels a loss - a sense of having missed his youth. "I still go to Los Altos, to the old house where I lived (before the lobotomy). Go to the schools that I went to. I get out of the car and walk around. I'd do it daily if I had time. For some reason it fascinates me.

"I think it gives me an attachment to when I had a family," he says, clearing his throat. "A normal family life. Mom and dad and brothers. Because from 12 years on my life was not normal."

Throughout his 20s and 30s, Dully had problems with alcohol, drugs and homelessness. He went sober in 1985 and quit smoking in 1994 after a heart attack. In his 40s, he went back to school and got a degree in computer information systems but found he was too old to find work in that youth-centric market.

"I'll never get to where my brothers are, because I started at 40 and they started at 20. I lost 20 years. It happened too late in some respects. That's just the way it is."

Dully credits his wife, Barbara, with putting him on a positive track. They met 22 years ago and got married in 1995. Wedding pictures show them in gown and tux, astride matching motorcycles. Dully has two sons, 30 and 27, from an earlier relationship and has worked as a bus driver for 10 years. He's on a leave of absence from San Jose Charter Bus while he promotes his book.

"My Lobotomy" began as a radio documentary on NPR's "All Things Considered" in November 2005. Producers Dave Isay and Piya Kochhar intended a profile on Freeman but when they found Dully, who had recently started researching lobotomy on the Internet, they fell in love with his story. They decided to focus on him instead, and urged him to narrate the piece in his gentle, resonant baritone.

Isay and Kochhar took Dully to Freeman's medical archives at George Washington University in Washington, D.C. "My file has everything," he says in the narration. "A photo of me with the ice picks in my eyes, medical bills. But all I care about are the notes. I want to understand why this was done to me."

The NPR piece captures a conversation with Dully and his father, Rodney, a former schoolteacher who was later divorced from Lou. "I was manipulated, pure and simple," his dad says in regard to the lobotomy.

But when Howard breaks down and professes his love to his dad, his father answers, "Whatever made you think I didn't know that? You shaped up pretty good!" He doesn't say "I love you" back.

"Ever since my lobotomy I've felt like a freak," Dully says at the end of the broadcast. (But) I know my lobotomy didn't touch my soul. For the first time, I feel no shame. I am, at last, at peace."

The response to the broadcast was huge. So many e-mails flooded in that NPR's Internet server collapsed. Today, Dully says, there's interest from Hollywood producers to make a TV movie or feature film from his book. "I'd love it, provided it's done with truth. I don't want any fictional account making someone out worse than they were or better than they were."

There's also a playwright in New York who, inspired by the NPR documentary, has written a play about Dully called "The Memory of Damage."

Dully, who looks like a Buddha as he sits in his favorite coffee shop, seems to regard the celebrity as a cosmic joke. For someone who spent his life plagued by self-doubts, who says he's still intimidated by his father, it's difficult to accept this attention.

"I tease my wife and other people, and say I have a swollen ego," he chuckles. "But I don't have any news people camping outside my door. I don't live in any mansion.

"My idea for writing the book was first to get a little closure - which I find a little selfish, but that's OK. The other reason was to help people to think about how we treat each other daily. Not just loved ones but everybody.

"Something you start here or say here may affect somebody's whole day, maybe their whole life. Ten minutes of what Freeman did to me has affected me for 47 years."

State petitions court over acquittal of psychiatrist on molestation charges

From this report from Isreal

The State Prosecution on Thursday petitioned the Supreme Court seeking to overturn the decision to acquit psychiatrist Marcello Spitz of child molestation charges.

In response, the health ministry said it would reconsider its decision to allow Spitz to resume practicing pending the court's decision.

A panel of Haifa District Court judges had acquitted Spitz by a vote of two to one, saying the prosecution was not able to prove his guilt beyond a reasonable doubt.

Spitz had been charged with repeatedly touching one of his patients. In their ruling, the judges said the witnesses' testimony was valid and that contrary to Spitz's claims he was not in a psychotic state.

However, they wrote that they had decided to aquit Spitz because they believed the patient's unstable mental state and will to leave psychiatric interment led him to believe a version of events of his own fabrication.

Judges had further doubts over the witnesses' claim that the acts were carried out by Spitz in an unlocked room while his mother was waiting outside and that he came forward only after the most serious incident.

In the petition, the State Prosecution claims the judges ignored the fact that Spitz lied in court, claiming he had diagnosed the youth as suffering from psychosis and delusions while records show he had not.

Feds, state warn Delaware Psychiatric Center about shredding evidence

From Delaware's The News Journal

Revelations that documents were being shredded at the Delaware Psychiatric Center at the same time federal and state agencies were investigating the hospital have prompted stern warnings from the United States Attorney's Office and Delaware Attorney General Beau Biden.

In a letter Friday to DPC, U.S. Attorney Colm Connolly's office warned Vince Meconi, secretary of the Department of Health and Social Services, that Connolly did not take the possible destruction of evidence lightly.

"We are concerned about this reported document destruction, and write to remind you and your employees of your duty to preserve any materials that may be relevant to reasonably foreseeable litigation, as well as your duty to not destroy or impair any documents so as to interfere with their availability in an official proceeding," wrote First Assistant U.S. Attorney David C. Weiss. "Accordingly, we ask that you cease any document destruction efforts that relate to DPC."

After revelations about patient abuse and retaliation against nurses who report the abuse were first chronicled last month in The News Journal, Connolly notified Justice Department regulators in Washington about possible civil rights violations at DPC. At least six state and federal agencies are examining conditions at the trouble-plagued state hospital, including a task force recently established by Gov. Ruth Ann Minner.

The News Journal broke a story about the shredding program last week. Meconi and other state officials said DPC was not involved, even though DPC's administration building was on the list of buildings visited by the contract shredding firm. According to the firm, the shredding operation ended Friday.

Connolly and Biden declined to comment for this story.

DPC director Susan Watson Robinson said only that she received Connolly's letter Monday, which "reminded us of our obligation not to shred any documents."

In a written response to the U.S. Attorney's Office, which Robinson provided along with the Justice Department warning, Meconi said that "no DPC documents have been destroyed or discarded, nor will they be destroyed or discarded during the course of any state of federal investigation or inquiry."

"All records pertaining to DPC remain intact and accessible to any law enforcement or monitoring agency," Meconi wrote. "In addition to your directive, we have previously been directed not to destroy or discard DPC documents by the state Department of Justice."

The "document shredding program" has prompted calls for Meconi's resignation from Rep. Gregory F. Lavelle, R-Sharpley, who described the shredding as "the straw that broke the camel's back."

It also prompted action from State Treasurer Jack Markell.

Markell sent a letter to the co-chairs of Minner's task force, Rita Landgraff and Peter Ross, requesting they "make every attempt to address a series of pressing questions being raised by Delawareans."

"Over the past several weeks, I have heard again and again while traveling the state a deep level of concern over the many and continuing unanswered questions about ongoing care at the Delaware Psychiatric Center," Markell said. "With this letter, I am hoping to bring a more focused voice to many of those concerns that I share with so many other Delawareans, and to request of Governor Minner's task force that they try to make every attempt to provide these answers to the concerned families and friends raising them."

In his letter to the task force, Markell asks a lengthy series of questions, covering a broad scope of problems identified in the ongoing News Journal special report.

"There's a lot of unanswered questions," he told The News Journal. "I think the task force's work could benefit the state and the public if they tried to answer some unanswered questions. The commission they've been given is important, but I think there's a lot of unanswered questions that could restore public trust. The letter speaks for itself, in terms of my motivations."

Markell wants the co-chairs of Minner's task force to determine whether security cameras -- promised early on during The News Journal's investigation -- have been ordered, and whether DPC would be better off with a psychiatrist in charge.

He also wants to know why a request made by The News Journal under the state's Freedom of Information Act for copies of every patient-abuse report filed since 2001 was rejected. He hopes that the task force reviews the forms.

Another series of Markell's questions pertains to documented patient abuse. On July 2, patient Preston Hudson's jaw was broken in three places inside DPC's admissions unit.

On July 15, The News Journal quoted Jay Lynch, spokesman for the Department of Health and Social Services, saying that Hudson's claims of being beaten by employees of the hospital "are not credible" and that Hudson tripped on the edge of a mat.

On Aug. 6, an attendant was indicted for second-degree assault and patient abuse in the case. Anthony R. Liggians Jr., 32, of Wilmington, was fired by DPC shortly before the charges were filed. His criminal case is pending.

"The original statement by DPC that the patient 'tripped' is, frankly, suspect, in light of this indictment," Markell wrote. "The Department's spokesman said hospital investigators initially relied on internal reviews and medical records to conclude Hudson's claims were not credible. What exactly did those medical records say? Did the doctor who performed the surgery indicate that the patient likely tripped? Is there to be any accountability beyond the indictment of the attendant?"

Of the shredding, Markell asked: "What is the shredding policy for DPC if one exists at all? What exactly was shredded and why was this particular time chosen for the shredding?"

On Monday, Robinson said Markell will get his answers during an upcoming public hearing by the legislative committee investigating DPC.

"All of these questions are the ones that we're looking forward to answering at the Sept. 11 hearing," Robinson said. "We're happy that in his letter, he acknowledges there are a lot of employees that are dedicated to providing high-quality patient care."

Markell is expected to face Lt. Gov. John C. Carney in a Democratic primary next year to replace Minner. On Monday, Carney said he called Meconi about the shredding.

Last week, Gov. Minner has expressed her "utmost confidence in Secretary Meconi and his leadership team."

Asked Monday if he shared the governor's confidence in Meconi, Carney repeated his concerns about the shredding.

"I am very concerned overall about this issue of public trust," Carney said. "I think the administration out there needs to change their attitude a little toward the whole process, and be more responsive to the questions being asked."

Judge steps down from psychiatrist fraud case

From the New Straits Times

A High Court judicial commissioner yesterday discharged himself from hearing a civil suit involving well-known psychiatrist Tan Sri Dr M. Mahadevan.

John Louis O’Hara, who was presiding in High Court 1, disqualified himself on the grounds that he knew the plaintiff personally through their involvement in polo.

O’Hara told both the plaintiff and defendant’s counsel in his chambers yesterday that he could choose to be impartial and continue with the hearing of the suit, but he did not want to put himself in a difficult position.

Mahadevan’s lawyer, Raam Kumar, said O’Hara then transferred the case to High Court 3, where Datuk Ghazali Cha is the presiding judge.

Mahadevan had filed a suit in 1998 against his sister-in-law, three nephews and two nieces claiming that they were trespassers in one of two houses built on a 1.6ha plot of land in Jalan Scotland here.
Raam Kumar said Mahadevan was asking for vacant possession of the property and for damages to be assessed against the six defendants, who were represented by K. Govinderaju.

The defendants filed a counter claim, stating that Mahadevan had fraudulently transferred the plot of land without the defendants’ knowledge in 1981.

They also stated that they had been staying at the house, No 10 Taman Scotland, since 1972.

Govinderaju said his clients were asking for the property to be returned to them.

Ghazali fixed Nov 14 for hearing.