The revised label, posted without fanfare last week on the F.D.A. Web site, says Seroquel and extended-release Seroquel XR “should be avoided” in combination with at least 12 other medicines linked to a heart arrhythmia that can cause sudden cardiac arrest.

Sandy Walsh, a spokeswoman for the F.D.A., said the statement was only a precaution for doctors, and should not be considered a complete ban against prescribing Seroquel with the other drugs.

Ms. Walsh said the label was changed after the F.D.A. received new information about reports of arrhythmia in 17 people who took more than the recommended doses of Seroquel. Though it should not be a problem at a normal dosage, she said, it may still be good advice to avoid using the drugs together.

The arrhythmia, known as prolongation of the QT interval, referring to two waves of the heart’s electrical rhythm, is estimated to cause several thousand deaths a year in the United States.

As AstraZeneca prepares to report its second-quarter earnings at the end of this month, it faces additional scrutiny this week. The F.D.A. is considering the London-based company’s dapagliflozin, a proposed diabetes drug with Bristol-Myers Squibb, and is expected to decide soon on Brilinta, an anticoagulant. The company is facing the loss of patents for Seroquel next year and for the heartburn drug Nexium in 2014.

Seroquel is one of the top-selling drugs in the world, at $5.3 billion last year, including $3.7 billion in the United States. Introduced in 1997, it has been approved for schizophrenia, bipolar disorder and severe depression. Seroquel has caused legal problems for AstraZeneca, including a $520 million payment in 2009 to settle government charges of illegal marketing. Thousands of lawsuits are pending over side effects like diabetes.

The previous Seroquel labels had mentioned the risk of a prolonged QT interval, but had not identified other drugs to avoid, Stephanie Andrzejewski, a spokeswoman for AstraZeneca, said Monday. The new warning also is separated from other warnings and precautions on the label, she said, “to provide some additional guidance to physicians” treating patients ”who are already at risk of QT prolongation.”

The new warning will be added to printed labels as soon as possible, Ms. Andrzejewski said.

The new label lists the other drugs to avoid as antiarrhythmic drugs like quinidine, procainamide, amiodarone and sotalel; antipsychotic drugs like ziprasidone, chlorpromazine and thioridazine; antibiotics like gatifloxacin and moxifloxacin; the anti-infective drug pentamidine; and synthetic opioids like levomethadyl acetate and methadone. The label also raises caution about use by the aged and people with heart disease.

James J. Pepper, a lawyer in Pennsylvania who is involved in drug litigation, has been arguing for months in letters to government officials that Seroquel has a potentially deadly interaction with methadone in regard to the QT interval.

“This is a huge, huge step,” Mr. Pepper said of the label change, though he said he thought it should be stronger.

Ms. Walsh said the F.D.A. action was unrelated to Mr. Pepper’s arguments.

Three months ago, Dr. Janet Woodcock, director of the F.D.A. Center for Drug Evaluation and Research, rejected those arguments in a letter to the Project on Government Oversight, a nonprofit group in Washington, which had also raised the issues. Dr. Woodcock wrote that a thorough agency review had found it “exceedingly unlikely” that patients faced an unreasonable risk from the interaction between Seroquel and methadone. The review found only one death that was probably caused by the interaction, she wrote.

Dr. Woodcock concluded that the F.D.A. would take no action to change the label. Ms. Walsh said that conclusion was still correct, because the F.D.A. had found no biological basis for a problem or unusual numbers of deaths at normal dosages.

Methadone use and deaths have increased drastically in recent years as more doctors prescribe it for chronic pain. The number of methadone prescriptions for pain in the United States rose to 4.3 million in 2010 from 2.2 million in 2006, IMS Health, an industry data firm, said Monday. The use for pain has surpassed that for heroin withdrawal and maintenance.

URL: http://www.nytimes.com/2011/07/19/health/19drug.html?_r=1

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Dr. Alan Gumer, 64, of Tamarac, Fla., pleaded guilty to one count of conspiracy to commit health care fraud after being charged on Feb. 15, 2011, along with 19 others involved in the scheme, on various counts of health care fraud, money laundering and other offenses.

Gumer was a psychiatrist at American Therapeutic Corporation (ATC), a Miami-based corporation that supposedly operated partial hospitalization programs (PHPs) in seven locations throughout South Florida and Orlando. Co-defendants included ATC; its management company, Medlink Professional Management Group Inc.; and the owners and lead manager of ATC, Medlink and the American Sleep Institute (ASI).

PHPs administer intensive treatment to patients suffering from severe mental illness, and Gumer admitted signing evaluations, notes and other medical documents for patients he knew didn’t need the intensive — and expensive — treatment for which ATC billed Medicare.

Gumer admitted signing papers without examining the patients or even writing and reading the statements he was signing. He also confessed to writing prescriptions for unnecessary psychiatric medications in order to fool Medicare into believing the patients qualified for PHP treatment.

The crooked doctor also referred hundreds of ATC patients to a related company and co-conspirator, ASI, for pointless diagnostic sleep disorder testing. Gumer’s co-defendants, ATC’s owners and operators, paid kickbacks to owners and operators of assisted living facilities (ALFs), halfway houses and patient brokers in exchange for ineligible patients which ATC and ASI could use to defraud Medicare. “Patients” sometimes received a cut of the kickbacks as well.

Overall, the ATC and ASI paid out millions of dollars in kickbacks in exchange for bogus Medicare beneficiaries who didn’t qualify for PHP services to attend illegitimate treatment programs so ATC and ASI could swindle Medicare for more than $200 million in unnecessary medically services.

Gumer’s role in the scheme was responsible for $19.3 million in fraudulent Medicare billing alone, and he faces a maximum of 10 years in prison and a $250,000 fine. Gumer’s sentencing is scheduled for January 2012.

ATC, its owners, and the lead manager of ATC, Medlink and ASI were charged with various counts of health care fraud, money laundering and other offenses in a separate superseding indictment unsealed on Feb. 15, 2011.

Two of the three ATC owners and the lead manager, as well as both ATC and Medlink, have pleaded guilty to more than $200 million in fraudulent Medicare billing and are scheduled for sentencing in September 2011. The trial of the third owner charged is scheduled to begin in August of this year. The remaining 17 co-defendants named in the indictment in which Gumer was charged are scheduled to stand trial in November 2011.

The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. Since its inception in March 2007, the Medicare Fraud Strike Force has charged more than 1,000 defendants who fraudulently billed Medicare for more than $2.3 billion.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

URL: http://www.walletpop.com/2011/07/08/psychiatrist-pleads-guilty-in-200-million-medicare-kickback-sch/

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Misconduct charges include accepting kidney from patient

The New York State Health Department has revoked the license of an Elmira psychiatrist who has admitted charges of misconduct including accepting a kidney from a patient.

Dr. Carlos Delos-Reyes received his license to practice medicine in New York in March 1987. His license will be permanently restricted, effective June 21, and he will be prohibited from practicing in New York State.

According to a statement of charges issued by the state Board for Professional Medical Conduct, Delos-Reyes provided psychiatric care to patients at St. Joseph’s Hospital in Elmira, Family Services of Chemung County Mental Health Clinic or at the patients’ homes.

The misconduct charges filed against him include gross negligence, moral unfitness, willfully making a false report and failure to maintain adequate records for each patient.

» Between January 2010 and October 2010, Delos-Reyes failed to document a patient’s psychiatric, drug and alcohol use histories, and didn’t notice the patient’s adverse reaction to lithium, a mood stabilizing drug that Delos-Reyes prescribed without first evaluating the patient’s baseline kidney and thyroid function. Delos-Reyes was also charged with prescribing Xanax, used to treat anxiety attacks, without documenting the prescription. He also transcribed a prescription for Wellbutrin, an antidepressant, in the patient’s medical records but didn’t actually prescribe the medication.

» Between December 2008 and October 2009, Delos-Reyes failed to coordinate his treatment of a patient with her therapist, did not appropriately follow up on the patient’s levels of Valproic acid, a mood stabilizer used to treat conditions such as epilepsy, and did not refer the patient for metabolic lab studies.

» Between November 2005 and April 2009, Delos-Reyes accepted a kidney from a patient while serving as the patient’s psychiatrist. He also prescribed several medications for the patient without adequate medical justification, failed to document the prescriptions, and, in one instance, allowed the patient to write his own prescription. He was also charged with keeping inadequate medical records for the patient.

» From August 2005 to April 2008, Delos-Reyes failed to consult a patient’s primary care physician before treating the patient for hypersomnia, a disorder characterized by excessive amounts of sleepiness, failing to maintain an appropriate medication list for the patient and allowing the patient to complete the physician’s section of his behavioral health intake evaluation.

» From January 2004 to February 2009, Delos-Reyes did not perform an adequate psychiatric evaluation of a patient and failed to refer the patient for lab work to monitor his blood glucose and triglyceride levels.

URL:  http://www.stargazette.com/article/20110616/NEWS01/106160393/Elmira-psychiatrist-lose-license

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Daily News Staff Writer
Posted: 06/09/2011 06:12:59 PM PDT
Updated: 06/10/2011 12:11:49 AM PDT

The wife of Dr. William Ayres, a once-renowned child psychiatrist now accused of molesting several of his young male patients, testified in court Thursday that her 79-year-old husband can’t remember conversations, mixes up his words and once forgot his son’s name.

“He asks a question, he asks the same question 10 minutes later,” Solveig Ayres said during her husband’s competency trial, which began this week in San Mateo County Superior Court.

Defense attorney Jonathan McDougall is seeking to prove that his client suffers from Alzheimer’s-related dementia to such a degree that he is not competent to stand trial again on nine counts of lewd and lascivious conduct with minors under the age of 14.

Several of the doctor’s former patients — now in their 20s and 30s — claim he molested them during physical and genital exams he conducted as part of psychiatry sessions. Ayres was prosecuted for the alleged crimes in 2009, but a jury could not agree on a verdict and a mistrial was declared. The district attorney’s office announced in August 2009 it would refile charges, just a month after the first trial ended.

In opening statements Thursday, Deputy District Attorney Melissa McKowan said she does not dispute that Ayres suffers from dementia. But she said he is capable of understanding the legal proceedings well enough to aid in his own defense. She told jurors that two court-appointed doctors will testify that Ayres is competent.

In
a competency trial, the burden of proof falls on the defense to prove that the defendant is incompetent, she added.

“I will never disagree with the fact that he has some cognitive impairment,” McKowan said. “That is going to be obvious. … But the fact that he is suffering from this mental defect does not mean he cannot stand trial for the crimes he is accused of.”

McDougall said he plans to call as many as seven doctors to the witness stand to cast doubt on Ayres’ competency.

“How is that person that is not able to remember the name of his son, able to function in the legal world?” McDougall asked during his opening statement.

Solveig Ayres, the first witness called by the defense, said her husband began worrying about his memory at the end of the 2009 trial — he couldn’t remember former patients who testified.

“He said, ‘There’s something wrong in my brain,’” Solveig Ayres said.

His condition has worsened since then, she said. William Ayres could not remember what time the judge had told them to be at court the day before. During meetings with McDougall to talk about the case, Solveig said she takes notes and reviews them with William to remind him what was discussed.

On one occasion last December, he couldn’t remember his son’s name, she testified.

Lately, she added, he has been mixing up his words. For example, while talking with her about the Russian composer Sergei Rachmaninoff, her husband said “Republican” instead of “Rachmaninoff.” Solveig testified that William makes lists of the words he switches and tries to find a correlation between them.

Under cross-examination, Mc-Kowan portrayed that as an indication that William Ayres is well enough to be aware that he is making mistakes and is trying to figure out why.

“So he will think rationally and logically even though, at a moment in time, he switched a word?” she asked Solveig Ayres.

The trial is scheduled to resume on Monday.

Email Diana Samuels at dsamuels@dailynewsgroup.com.-

URL: http://www.mercurynews.com/breaking-news/ci_18242724?nclick_check=1

Related stories: Ayres’ Dementia Too Severe For Him To Face Molestation Charges

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Opening statements were given in San Mateo County Superior Court this morning in the competency trial of William Ayres, 79, who has been charged with nine counts of performing lewd acts with seven boys during psychiatric examinations that took place between 1991 and 1996.

Ayres admitted in a 2009 trial that he conducted exams in which boys were naked from the waist down, but said that nothing inappropriate happened. The trial ended in a hung jury when jurors were unable to reach a unanimous verdict on any of the counts.

The district attorney’s office decided in August 2009 to retry the case, but criminal proceedings have been suspended to allow a jury to decide whether Ayres remains competent enough to face charges.

In his opening statement Thursday morning, defense attorney Jonathan McDougall said Ayres’ mental deterioration has made it increasingly difficult for his client to understand his place in the legal proceedings or aid in his own defense.

McDougall said that at times, Ayres is unable to remember his own address, what he ate for dinner or the name of his son.

Deputy District Attorney Melissa McKowan said court-appointed psychiatrists agree with the defense that Ayres is showing signs of early-onset dementia and mental atrophy, but that the defendant remains well aware of the charges against him and is fit to stand trial.

Testimony in the competency trial began later Thursday morning.

URL: http://www.ktvu.com/news/28185802/detail.html

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BUENOS AIRES, Argentina » A psychiatrist who has spent a lifetime traveling the world, meeting famous people and giving spiritual awareness lectures has been arrested in Argentina on charges of falsely billing $1 million in health insurance claims in Hawaii, authorities said Tuesday.

Dr. Carlos Livio Warter, 61, was arrested Monday afternoon at his home in a wealthy Buenos Aires neighborhood, where he had been working as a psychiatrist and leading seminars based on his latest book, “Pathways to the Soul.”

He will be extradited to the United States, said Osvaldo Magnoli, chief of fugitives investigations for Interpol in Argentina.

A Chilean-born naturalized U.S. citizen, Warter traveled regularly to Argentina, Chile and Hawaii, FBI special agent Tom Simon said in Honolulu.

Simon said FBI agents working out of the U.S. Embassy in Buenos Aires were coordinating with their Argentine counterparts on the extradition.

Warter says on his website that he has spent 30 years “journeying between the fields of western medicine and the deep exploration of spiritual practices from around the world,” doing his residency at Harvard University’s Children’s Hospital and later lecturing at Esalen Institute.

He has written dozens of books in Spanish and English, and his site shows photos of him meeting with world leaders from Robert F. Kennedy Jr. to the Dalai Lama, Pope John Paul II, Brazilian soccer legend Pele and former U.S. Secretary of State Colin Powell. The site says his nonprofit groups include the World Health Foundation for Development and Peace, Heartnet International and Gota de Miel (Drop of Honey), which aided orphanages in Latin America.

A federal grand jury indictment accuses Warter of knowingly sending about $1 million in inflated bills to Medicaid, the Hawaii Medical Service Association and TRICARE, a federally funded program that provides care to military personnel. It alleges he overbilled for sessions that didn’t last as long as he claimed, and even billed for sessions when he wasn’t physically in the state, pocketing more than $530,000 to which he wasn’t completely entitled.

In addition to the federal indictment, Warter was charged in August 2009 with 37 state felonies accusing him of Medicare fraud, each punishable by up to five years in prison. This February he voluntarily surrendered his medical license for failure to comply with professional conduct laws, said Connie Cabral, executive officer of the Hawaii Medical Board, which is attached to the state Department of Commerce and Consumer Affairs.

Argentine police said Warter, who is married and has four children, has been living for more than a year in Argentina. A woman answering his phone in Buenos Aires refused to comment Tuesday.

Jim Carter, listed by Warter as a U.S. contact for his seminars, said the arrest “has got me flabbergasted.”

“Everything I’ve done with him has been on the up and up, and he’s made a big positive impact on my life. I’m sure a lot of other people will say the same thing,” said Carter, who lives in the Lansing, Mich., area and began following Warter’s advice years ago.

“His day job is psychotherapy, and the other stuff he does is life coaching, with a spiritual bent,” Carter said. “A lot of his work is showing people how their ego is interfering, and to get that out of the way so their essence can grow.”

Associated Press writers Almudena Calatrava in Buenos Aires and Jennifer Kelleher and Mark Niesse in Honolulu contributed to this report.

URL: http://www.staradvertiser.com/news/hawaiinews/20110525_Psychiatrist_accused_of_overbilling.html

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Admits to prescribing drugs online without seeing patients

St. John’s psychiatrist Dr. Mohamed Mekawy fought back tears Thursday at a medical board disciplinary tribunal hearing while apologizing to his family, patients and colleagues for causing them shame.

Mekawy, who admitted to prescribing medications online to patients in the United States without seeing or assessing them, was given a four-month suspension, dating back to March 7 when his licence was suspended by the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL).

He’s also been ordered to complete a prescribing course, sign a written undertaking that he will not prescribe medications via the Internet and pay a portion of the costs for Thursday’s hearing, in an agreed amount of $10,000.

These sanctions, which were proposed in a joint legal submission by his lawyer Peter Browne and the college’s lawyer Lewis Andrews, were accepted Thursday afternoon by the disciplinary tribunal.

The full decision will also be published by the CPSNL.

After the tribunal’s decision, Browne asked if Mekawy could make a statement. The doctor said he was “ethically blinded” by assurances he was given by an Internet drug company that he could prescribe to patients in this manner.

Mekawy had his medical licences suspended in Indiana, Michigan and South Carolina in 2007, but failed to report that to the Newfoundland board and falsely answered no to questions regarding any suspensions, reprimands, restrictions or disciplinary actions in other jurisdictions in a 2008 application for licence renewal in this province.

In a letter of response to the Newfoundland board in 2010, after it discovered he provided false answers on the applications, Mekawy said his “profound sense of shame” affected his judgment to the point that he chose not to mention the incident with the U.S. medical authorities.

He told the tribunal Thursday he takes full responsibility for his actions, has learned some serious lessons and promises to never engage in such unethical practices again.

The tribunal, chaired by Dr. Jody Woolfrey, with members Dr. Ed Collins and John Whalen, heard that Mekawy began practising medicine in Newfoundland in 2003. He also held licences in the U.S. states of Indiana, Michigan and South Carolina.

The Newfoundland medical board received information from the Federation of State Medical Boards of the United States in August 2010, providing a summary of reported actions regarding Mekawy’s medical licences in Indiana, Michigan and South Carolina. His licence was temporarily suspended in Indiana in late 2007, after which he voluntarily withdrew his Indiana licence prior to or in lieu of an inquiry and agreed to never again apply for a licence in that state.

Mekawy’s licences in the two other states were subsequently suspended.

Mekawy explained in his letter to the Newfoundland board, he received correspondence in 2007 from a company expressing interest in having him provide prescribing services to its Internet pharmacy, USACHOICEMEDS.com.

He said he spoke to a man by phone who said the company provided assistance to people in the U.S. who had difficulty obtaining health insurance.

Mekawy agreed to issue prescriptions for a fee and said he provided this service for about two months in July and August, 2007.

“The general protocol I followed involved the receipt of a completed questionnaire by a patient on my home computer which contained pertinent medical information along with a request for medication. I would review this information and either agree or disagree with the request,” Mekawy said.

He also said he didn’t knowingly prescribe controlled medications because he was not aware that one drug he prescribed, Soma, was considered a controlled drug in some U.S. states.

After the Indiana medical board informed him his licence was being suspended, Mekawy said the Internet drug company provided him with no support or assistance.

He said his licences in Michigan and South Carolina were also suspended, “likely due to a reciprocity agreement with the Indiana Medical Board,” but Mekawy said he didn’t use his licence in either of these two states when issuing prescriptions for the online company.

Documents filed with the Medical Licensing Board of Indiana say the investigation into Mekawy began when the Office of the Attorney General initially contacted an investigator with the Arkansas State Police who interviewed people who had obtained prescription drugs over the Internet.

In one case, a wife admitted she used her husband’s credit card to obtain the drug Soma from the online Internet pharmacy to feed her drug addiction. She admitted she never saw the doctor prior to receiving the medication. Another patient obtained Soma with his personal credit card without ever seeing Mekawy.

Indiana documents also note that Mekawy is under investigation by the Medical Board of California after an individual that he prescribed Soma to was hospitalized after overdosing on this medication.

Other drugs he was reported to have prescribed included pain medications, sleep aids and drugs to treat sexual dysfunction. Tramadol, Butalbital, Viagra, Rozerem, Ultracet, Cialis and Levitra are cited in one of the documents.

The Indiana board concluded that Mekawy’s actions represented a clear and immediate danger to public health and safety.

His lawyer, Peter Browne, expects Mekawy’s Newfoundland licence to be reinstated in July. He said he has enrolled in a two-day prescribing course in Ontario in September.

Brown also presented to the tribunal two letters of support from Eastern Health managers, Dr. Kevin Hogan, a former clinical chief of mental health and addictions and Dr. David Atwood, the current clinical chief.

Atwood said Mekawy’s online prescribing didn’t “creep” into his psychiatry practice and he had no issues with his competency. In fact, Atwood said his prescribing of psychopharmacology drugs was on a “more conservative range.”

Praising his clinical skills, Atwood said Mekawy has “strong character and reliability” and he has high personal and professional regard for him. He said if Mekawy’s licence is reinstated, he would have no problem returning him to his position at Eastern Health.

dss@thetelegram.com

URL: http://www.thetelegram.com/News/Local/2011-05-13/article-2503165/Psychiatrist-gets-fourmonth-suspension/1

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CoxHealth terminated six employees and overhauled its policies for psychiatric patients after a suicide at Cox North in December.

An inspection, triggered when CoxHealth self-reported the suicide to the state, found that employees falsified paperwork about how often they checked on the safety of psychiatric patients.

Anthony Gillham, 34, who was described as homeless in state reports, hanged himself in a 50-minute period on Dec. 5 when staff at the Adult Psychiatry I unit failed to monitor him as required, according to a report from the state Department of Health and Senior Services. The report said employees filled out paperwork indicating that they had checked on him every 15 minutes, but video showed the man hadn’t been checked on from 4:20 p.m. to about 5:10 p.m., when the man’s roommate discovered him and began screaming.

The inspection, done after the state Department of Health and Senior Services was notified Dec. 7, found that the problems at Cox North “created an unsafe psychiatric patient care environment.” The inspection, which began Dec. 9, found that the hospital was out of compliance with federal requirements to receive payments from Medicare and Medicaid. That means the hospital was at risk of losing these payments.

Jacqueline Lapine, the spokeswoman for the state Department of Health and Senior Services, said the hospital took immediate action to correct the problem. When the agency left on Dec. 15, the safety of psychiatric patients was no longer considered to be in immediate jeopardy, Lapine said.

Lapine said Cox had 90 days to fix the problems that could have affected payments from Medicare and Medicaid. The agency returned to survey the hospital and found conditions acceptable.

Laurie Duff, the vice president of corporate communications for CoxHealth, said the company “is committed to providing patients with the best and safest possible care.”

Gillham’s death is the only suicide that has happened at the psychiatric facility. The hospital has four inpatient units for psychiatric patients – two adult, one senior adult, and one child/adolescent. The first unit opened in the 1980s.

Nationwide, there were 67 suicides at hospitals last year, according to The Joint Commission which accredits hospitals. Two suicides were reported at hospitals in Missouri last year.

“We are greatly saddened by this tragic event and offer our deepest sympathies to the patient’s family,” Duff said in a statement. “Due to privacy laws and pending litigation, we are unable to discuss the details of the situation. However, we can say that we have taken this situation very seriously. Immediately following the incident, we conducted a thorough investigation and put in place extensive additional measures to ensure the safety of the patients on the unit. We also self-reported the incident to the Department of Health and Human Services and cooperated fully with its investigation. We submitted our plan of correction to DHHS, which was approved, and all items outlined in our plan have been implemented.”

The News-Leader was unable to find any civil lawsuits connected to the death in online records or at the Greene County Clerk’s Office. However, sometimes litigation can be signaled with a notice to a party without a public docket being started.

Changes outlined in the correction plan include requiring psychiatric patients to remain in view of hospital staff during waking hours, hiring more employees to help monitor the patients, and checking patients at 12- to 18-minute intervals. That is designed to limit patients’ ability to predict when they will be checked.

The hospital also removed potentially unsafe objects from patient rooms such as heavy shower curtains and updated a policy for resuscitating patients.

The hospital told state regulators that six staff members were put on administrative leave and terminated in January “for improper documentation and/or inadequate supervision.” Staff members were not identified by name, but they included a charge nurse and a unit manager. An assistant unit manager “was counseled and placed on an action plan to address deficiencies in supervising,” according to the plan of correction CoxHealth gave the state.

Fifty-two patients were at the Cox North psychiatric units about the time Gillham died. The facility is licensed for 72 psychiatric beds. The psychiatric ward provides treatment for people with mental disorders, including patients who are suicidal.

The News-Leader obtained the details of the suicide at CoxNorth after a records request to the state seeking its most recent inspection reports for the CoxHealth system. Other details from the state’s findings, called a “summary statement of deficiencies,” include:

» Gillham, who was unemployed and estranged from his family, had been living in a homeless shelter and had previously attempted suicide. He was released from another psychiatric facility about a day and a half before coming to the emergency room complaining about auditory hallucinations and thoughts of harming himself. He was admitted to the psychiatric unit for recurrent major depression.

» On Dec. 5, Gillham talked about plans for Christmas and was looking forward to positive things, according to a review of medical records mentioned in the agency’s report. Paperwork said that staff at Cox North had checked on him at 4 p.m., 4:15 p.m., 4:30 p.m. and 4:45 p.m. and indicated that he was behaving appropriately. But video showed that staff didn’t check on Gillham after 4:20 p.m. At 4:23 p.m., he was seen on video sticking his head out of the room and looking into the hallway. At 4:24 p.m., the door to the room closed. At 5:10 p.m., Gillham’s roommate found him with a sheet tied around his neck and looped over the door.

» Employees told an investigator that they would at times — the report didn’t note how often — write that they had done safety checks on psychiatric patients even though those checks hadn’t been performed.

» After Gillham was discovered, an employee called for help in trying to resuscitate him, but didn’t use the switchboard, meaning emergency room staff weren’t notified. The call was limited to the intercom for psychiatric units only. Advanced life support efforts didn’t start until Gillham was taken to the emergency room at Cox North.

» The investigation also found that the psychiatric facility was short-staffed on the day Gillham died with only one psychiatric technician responsible for 13 patients in the section that Gillham was in. On Dec. 5 one of the psychiatric technicians assigned to cover the 3 to 11 p.m. shift called in sick, leaving only two technicians assigned to the adult halls.

The staffing guidelines called for the charge nurse to ensure sufficient staffing, but the hospital told the state that the employee failed to secure additional staffing or ask for help in getting additional staffing.

URL: http://www.news-leader.com/article/20110513/NEWS01/105130329/1007/?odyssey=nav|head

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KERANA TODOROV | Posted: Thursday, May 5, 2011 6:15 pm

A bill designed to make it easier to involuntarily medicate Napa State Hospital patients deemed incompetent to stand trial received the green light from a state Assembly committee this week.

The measure is one of several introduced in the state Legislature this year to improve safety at the five state psychiatric facilities where violence remains a top concern.

Assembly Bill 366, co-authored by Assemblyman Michael Allen, D-Santa Rosa, allows a committee at each state hospital to authorize the involuntary medication of patients who refuse to take antipsychotic drugs for up to 21 days while the courts review their case.

The bill also requires judges to rule if patients lack the “capacity” to make decisions on whether or not to take antipsychotic drugs.

Currently, patients who are sent to state hospitals because they are deemed incompetent to stand trial and who refuse to be medicated may go without antipsychotic drugs for months while their case is reviewed by the courts, said Dr. Patricia Tyler, a psychiatrist at Napa State and a member of the Union of American Physicians and Dentists, the doctors union that strongly supports AB 366.

Patients may decide to refuse medications because they don’t believe they have a mental illness, Tyler said.

A quarter of patients who are incompetent to stand trial arrive at the hospital without a court order allowing involuntary medication, Tyler said, citing figures from the state Department of Mental Health.

This state agency oversees California’s five state psychiatric hospitals, including Napa State, where the lack of staff and patient safety has made national headlines with a patient accused of strangling psychiatric technician Donna Gross in late October.

“This is about creating a safer environment for patients and staff, one that they both expect and deserve,” Allen said this week. “To do that we must make changes to the security infrastructure of the various facilities and provide the necessary tools for effective medical treatment,” he said.

The bill, Allen said, improves the current involuntary medication process by eliminating gaps for patients who are incompetent to stand trial and committed to a state hospital.

Under the bill, judges determine at the initial trial if the patients have the capacity to make decisions regarding antipsychotic medications. The requirement, Allen told a committee earlier this week, eliminates unnecessary and redundant court hearings.

The bill received unanimous support Tuesday from the state Assembly Committee on Public Safety. Allen’s chief of staff, Sean MacNeil, expects the bill to be amended as it moves forward through the legislative process.

The two-member local committees proposed in AB 366 include a patient advocate and a non-treating psychiatrist. The bill may be redrafted to include a third person, MacNeil said.

Tyler noted that local committees to review involuntary medications were formerly in place at Napa State but stopped in last fall at DMH’s directive. That happened after a Coalinga State Hospital patient successfully challenged the practice, MacNeil said.

Disability Rights California, a statewide organization that advances the rights of Californians with disabilities, opposes the bill unless it is amended, Margaret Johnson, the nonprofit’s director of advocacy, said Thursday.

Disability Rights California wants to protect people’s rights to due process. “That’s our primary concern,” Johnson said.

She said Disability Rights California is in negotiations with Allen’s office. “We have been working with Michael Allen on suggested amendments,” she said.

Ronald Abernethy, Napa County’s chief public defender, expressed reservations about the bill, noting that “the issues surrounding the involuntary administration of anti-psychotic medication are complex.”

“The desire to authorize the involuntary medication of every mentally ill criminal defendant, the seeming goal of AB 366, is understandable,” Abernethy said in an email.

“Unfortunately, the statute offers few real protections of an individual’s constitutional right to be free, except in narrowly defined circumstances, from the forced administration of powerful drugs over a patient’s objection.

“Whether AB 366 in its current form would pass constitutional muster, under guidelines provided by the U.S. Supreme Court in the Sell decision, remains to be seen,” he said.

Jennifer Turner, spokeswoman for the Department of Mental Health, said the agency has not taken a position on AB 366.

URL: http://napavalleyregister.com/news/local/article_a8a04d66-777c-11e0-9f2c-001cc4c002e0.html

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Statistics from Birmingham and Solihull Mental Health Trust show that, in the last year, 51 people in the city were treated with the controversial therapy, of which 22 were detained against their will.

According to guidelines from the Mental Health Foundation (MHF), the treatment should only be used for severe depression where a life is at risk.

But the Birmingham figures show it was also given to catatonic and prolonged manic cases.

A trust spokesman said it was difficult to quantify the effectiveness of ECT as it was given in conjunction with other therapies.

Michael Dunn, aged 59, of Erdington, was first treated after attempting suicide in his teens.

Diagnosed with bipolar at Highcroft Hospital, in Erdington, he was administered a weekly course of electroconvulsive therapy (ECT).

Over the next 20 years, he received the treatment more than 20 times.

Michael said it was only effective in the short term at jolting him out of his depression and the more he had it, the less effective it was.

What’s more, it left him with severe memory loss. “I feel like I’ve had parts of my life blanked out. There’s whole chunks that I can’t remember,” he said.

“I suppose it did lift the depression for a short while but it always came back.

“I would never have it again. I have found that just talking to people and taking medication has been far more effective.

“In this day and age, it shouldn’t be used. It’s barbaric.”

Dr Andrew McCulloch, from the MHF, said it should only be used “as a last resort”.

“It can have very serious side-effects, including memory loss, yet it can lift a person quickly out of a life-threatening depression,” he said.

In Birmingham, the treatment is used at the Oleaster unit, at the Queen Elizabeth hospital. The unit is currently undergoing its three-year audit by the Royal College of Psychiatrists.

URL: http://www.birminghammail.net/news/birmingham-news/2011/05/05/electric-shock-therapy-blanked-out-parts-of-my-life-says-erdington-man-97319-28638091/

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