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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I would like to address the subject of medicating students at the school’s “request” or demand is more like it. This is our family’s experience.

My 12-year-old grandson is ADHD and does have some social and some behavioral issues. We are well aware of his issues and do not try to dismiss them. The school has tried to insist that he be medicated. His mother has refused to medicate him because of the damage from the ADHD drugs to his older brother. This has been explained many, many times to the school personnel.

The side effects of the drugs, Concerta, Strattera, Ritalin and Seroquel vary and the intensity varies from person to person. My older grandson who has taken these various drugs has had severe reactions to them. Some of his reactions are delusions, paranoia, the need for higher doses consistently, mood swings, and when the doses were changed to higher levels, uncontrollable anger. My daughter’s refusal to medicate the younger son stems from the reactions of her older son to the drugs.

When the school was told no, they constantly asked the child if his mother had taken him to the doctor and told him he needs to be medicated. It is very sad that a child comes home and tells his parent that he needs to be medicated. In response to her refusal and the arguments that ensued over the issue, the school has exacted what in my opinion is revenge on the child for his mother’s decision to do what she believes is best for him in the long run.

They put in place a discipline plan that my daughter did not approve of or sign but it didn’t matter. I understand that some of detentions were deserved but I disagree with the nitpicking. Examples and these are just a few: Forgetting a pencil, being early to class, being put in detention for not spitting out gum when in fact the child had and the proof was in the trash can, telling another person that they don’t want him around and he can hear it. The detentions for these silly nitpicking items added up and have created a real problem on the child’s record.

The real topper for me is the fact that they allowed him to sign up for an overnight camping trip and then decided my grandson could not go because of his record and missing assignments. How strange when we checked online to see if there are any missing assignments, they show as completed.

There are many more details to this situation. The bottom line is that they have humiliated, belittled him openly and made this child feel very unwanted. No child reacts well to this type of treatment, no child deserves this. I believe that the school lacks education in some of these disorders and needs some training. If trained properly they would be able to identify that the social, behavioral issues and learning disabilities are a part of the complex disorder and there are better ways to handle the problems.

I would be curious to know how many children are medicated and how many times the school recommends the medication because it makes the staff’s life easier. They have no concept of the long-term effects of the drugs. They are not doctors. I would also be interested in knowing how many others had experiences like this.

I am sure that this will evoke a response again blaming all of the poor behavior on the child, but I think that the professionals should take a deep look at themselves and evaluate why they behave as they have.

Diana Strohm
Muskegon

URL: http://www.mlive.com/opinion/muskegon/index.ssf/2011/06/letters_should_a_school_insist.html

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When Judge Robert Heinrichs renders sentence on August 4, will your portfolio be the one to take the fall?

On that date, it is expected that the judge will make his rulings on sentencing for a teenage boy, arrested after allegedly killing a fellow teenager in what one doctor calls a clear case of “Prozac reaction.”

“There is no reason other than a Prozac reaction,” said Dr. Peter Breggin, a New York state-based psychiatrist and author of the book, Talking Back to Prozac. “(The killing) is a mystery without that.”

The entire affair starts with, of all things, an accidental dent put in the wood floor of the home of the accused by the victim. The accused, who was not home at the time of the accident, later invited the boys back to his house to hang out. When they were hanging out, the accused pulled out a knife and stabbed the boy in the chest.

The accused had been treated for depression and was prescribed Prozac three months prior to the killing. Some studies link the drug Prozac, first patented by Eli Lilly (NYSE: LLY) with behavioral and emotional changes in users under 18 years of age, including an increased risk of suicide.

After days after he began taking Prozac, the accused attempted suicide with some medication of his grandfather’s. His parents complained to the physician that, rather than help, the drug was making the boy’s condition worse. Rather than switch to a different drug, doctors increased the dosage of Prozac.

“It was a prescription for violence,” Breggin wrote in a report for the defense.

“Within a reasonable degree of medical certainty, I believe that Prozac drove (the accused) into a state of severe agitation with manic-like symptoms including mood swings, confusion, irrationality, extreme irritability, hostility and violence.”

Breggin said the teen should have stopped taking Prozac immediately after he attempted suicide.

“Right then and there should have been the end of the Prozac,” Breggin said. “When you have a drug that is causing mania, you stop taking the drug.”

Now, one boy is dead and another is in the morgue. Will Eli Lilly’s stock take a tumble after the verdict, or will the judge find the boy’s Prozac defense is nonsense? Will other lawsuits emerge? It could be a rough season of discontent for Eli Lilly.

Read more: http://www.benzinga.com/news/global/11/06/1142243/will-prozac-murder-trial-doom-eli-lilly-stock

Related stories:  Did Prozac Cause Teenager to Kill? Psychiatrist Says Yes

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The 17-year-old teen, who was not named in the media, stabbed a 15-year-old friend after the other teen caused damage to a hardwood floor in his friend’s home. The disproportionately angry response, explains Dr. Peter Breggin, is a not-unknown side effect of the antidepressant Prozac. Dr. Breggin stated:

“There is no reason other than a Prozac reaction,” said Dr. Peter Breggin, a New York state-based psychiatrist and author of the book, Talking Back to Prozac. “(The killing) is a mystery without that.”

Nine days after starting therapy with the drug, the teen attempted suicide via an overdose of his grandfather’s pills. His parents reported the incident to doctors, who increased the Prozac dosage for the teen. Dr. Breggin says:

“It was a prescription for violence,” Breggin wrote in a report commissioned by the defence. “Within a reasonable degree of medical certainty, I believe that Prozac drove (the accused) into a state of severe agitation with manic-like symptoms including mood swings, confusion, irrationality, extreme irritability, hostility and violence.”

Prosecutors contend that the killing was a “conscious decision” made by the teenager, and that he should be accountable for the act of violence. In previous studies, Prozac has been linked to “emotional changes” and increased suicide risk in teens.

URL: http://www.inquisitr.com/111789/did-prozac-cause-teenager-to-kill-psychiatrist-says-yes/

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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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A report by the Mental Health Commission shows that more than half (57 per cent) of patients in acute or long-stay units were prescribed sedatives or benzodiazepines last year.

Clinical safety guidelines state that these drugs, which are typically used as medication for anxiety and as night sedation, should only be used after alternative therapies have been explored.

The commission’s report shows the rate of prescribing within individual psychiatric units ranged in some cases as high as 97 per cent.

It found that while the use of benzodiazepines has decreased slightly compared to figures collected in 2008, it continued to be high in many units.

“The lack of therapeutic services and programmes, as well as poor knowledge about the problems of benzodiazepine prescribing, may account for this,” the report found.

Inspection reports show that significant numbers of long-stay patients have been administered the drug for years even though guidelines state they should be used for the “shortest possible length of time and in the smallest possible dose”.

While small numbers of people may require benzodiazepines in the longer term, such as those who are severely dependent on them, the report says methods are available for withdrawing these kinds of patients from the drug.

It also found that the practice of combining more than one benzodiazepine was quite common (26 per cent of all residents) despite the lack of evidence of its therapeutic value.

Inspectors did, however, point out this practice has fallen significantly in recent years.

Former inspector of mental hospitals Dr Dermot Walsh yesterday said he had long-standing concerns regarding the overuse of these drugs.

“These are drugs of dependence and it’s clear they should only be used in short-term and acute situations, and usually for a very short period of time.

“It still amazes me when I see that patients are placed on these drugs almost on a routine basis when they come into hospital.”

He said the issue of benzodiazepines in medicine generally, especially primary care, was a problem.

The report also examines the use of anti-psychotic drugs which are used to treat symptoms of psychosis as well as schizophrenia and other mental health problems.

Inspectors found that 80 per cent of patients were receiving this form of medication.

Clinical guidelines advise against prescribing more than one anti-psychotic medication with limited exceptions. In its review inspectors found that 28 per cent of residents were receiving two or more anti-psychotic medications.

On a positive note, inspectors found that the practice of combining anti-psychotic medication is on the decrease and is below levels seen in international practice.

The use of doses of these medicines above the recommended dosage is also low (10 per cent) compared with international studies (in the UK it is about 20 per cent).

The report says there was evidence from a small number of centres that benzodiazepine prescribing had reduced and the quality of prescribing had increased following audits.

It says the vast majority of prescriptions authorising drugs to be administered to patients whenever it was required did not have a time limit or review date.

In its recommendations the report says each centre should conduct regular audits of medication prescribing and calls for training and education in safe prescribing.

URL: http://www.irishtimes.com/newspaper/ireland/2011/0504/1224296002783.html

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A yearlong investigation by the federal government confirmed what mental health advocates in the state have long maintained: New Hampshire does not have adequate community support systems for people with mental illness.

As a result, individuals are institutionalized in more expensive and more restrictive settings, primarily the New Hampshire Hospital in Concord and Glencliff Home, a nursing home for people with mental illness in Benton.

“In spite of a challenging fiscal environment, the state has continued to fund costly institutional care, even though less expensive and more therapeutic alternatives could be developed in community settings,” the study found.

The situation is particularly frustrating because the state could actually be spending less money to get better results for people struggling with mental illness. As the report points out, reliance on institutional care is not only less effective and more expensive, it violates the civil rights of people with disabilities.

While some may see this as another example of federal overreach, the fact is that Congress did pass the Americans with Disabilities Act, and the Department of Justice has to enforce it. If New Hampshire does not take appropriate action, it could face a costly federal lawsuit.

None of this comes as a surprise to lawmakers and state officials. New Hampshire already has a blueprint for improving mental health services – a 10-year plan released in 2008.

The plan called for creating “supporting housing,” where individuals get housing subsidies and community treatment, expanding residential treatment programs, providing additional mental health beds in community hospitals, and developing “Assertive Community Treatment teams,” which provide services like nursing and case management in the community.

But as is often the case, the plan has never been funded. There has been no money for adding community mental health beds; additional treatment teams were never created; no additional community hospital beds have been provided.

The roadmap is there, and it must be implemented.

“Many of the things the Department of Justice cites as ways that the state is falling short of its obligations would be remedied by simple adherence to the 10-year plan as it was outlined,” Jeff Fetter, president-elect of the New Hampshire Psychiatric Society, told the Concord Monitor.

Instead, the state is moving in the opposite direction. The recently passed House budget recommended major cuts to community mental health centers, removing eligibility for about 7,000 community mental health patients. Many of them would end up in institutions, costing the state more money and impeding their chances for recovery.

The budget is now pending in the state Senate, which must restore the mental health center funding, especially in light of the federal report.

Gov. John Lynch has proposed closing a New Hampshire Hospital unit and using the money to create two community treatment teams. This is exactly the approach the state needs to take on this critical issue, not just to avoid costly federal sanctions, but because it’s the right thing to do.

URL: http://www.nashuatelegraph.com/opinioneditorials/916250-263/mental-healthsystem-is-failing.html

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NAPA, Calif — A six-month Cal-OSHA investigation triggered by the murder of a psychiatric technician has found several safety inadequacies at the troubled Napa State Hospital and levied more than $100,000 in fines, according to documents released to KTVU Wednesday.

The state agency found the violations while investigating the circumstances behind the murder of Donna Gross at the hospital last October.

Cal-OSHA said it found a “lack of adequate employee alarm systems on the units, non-existent alarm systems in the STA outside of the units, inadequate police presence in the event of assaults, no enforcement of written policies …by the employer, and an ineffective Injury and Illness Prevention program.”

The hospital was ordered to correct specific violations, by either April 25 or May 15, depending on the type of violation.

The hospital can appeal the fine, but must correct the violations, state officials said.

Meanwhile two California lawmakers were decrying safety conditions at state-run mental hospitals and calling on the governor to push for immediate improvements.

State Sen. Noreen Evans and Assemblyman Michael Allen in a letter Tuesday called the level of violence at Napa State Hospital and others “unacceptable.”

On Monday night, a hospital patient died when he was subdued after he allegedly attacked his roommate, a Napa County sheriff’s captain said.

William Roebling, 47, allegedly attacked another patient in ward T-12 at the hospital just after 5 p.m. Monday, Capt. Tracey Stuart said.

Roebling died when psychiatric technicians intervened in the attack and subdued him, Stuart said.

Roebling was given CPR, but he was pronounced dead at 5:43 p.m., Stuart said. An autopsy is scheduled for today.

The patient who was attacked was not injured, Stuart said.

Roebling was being held in a secure area of the hospital, indicating he was not at the hospital under a civil commitment, Stuart said.

Hospital staff members have renewed calls for increased security at the hospital since Gross’ death in an outdoor courtyard on Oct.23.

Patient Jess Williard Massey, 37, is suspected of strangling Gross and stealing her jewelry, some gum and less than $2. His preliminary hearing is scheduled for May 2 in Napa County Superior Court.

Since the murder, two other Napa State Hospital patients who were charged separately with assaulting hospital employees have been found incompetent to stand trial and were ordered back to mental health hospitals.

URL: http://www.ktvu.com/news/27534002/detail.html
Related story: Patient dies at Napa State Hospital

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ABC7 learned the incident happened on Monday afternoon, between 5 and 6 p.m. in a high security section, surrounded by fencing and razor wire. It is an area where people found incompetent to stand trial are housed.

According to the sheriff’s department, 47-year-old William Roebling was subdued after he allegedly attacked another patient. The staff performed CPR, but Roebling died at the hospital and now staff members are worried what other patients might do.

“There’s some individuals, some of the patients, who are now threatening other staff because one of the patients died. And patients and staff are both really worried. They’re scared. They’re scared that something else is going to happen,” said Kathleen Thomas-Morris, a SEIU steward.
Tuesday St. Sen. Noreen Evans and Assm. Michael Allen sent a letter to the governor saying “Quite simply, this ongoing situation in our state hospitals is unacceptable — and deadly. More than 80 percent of those being treated at state hospitals arrive… through the criminal justice system. It is time we have laws, regulations, and on-site practices employed that reflect this new reality.”

Earlier this year employees held several protests demanding more peace officers, a campus-wide alert system and more staffing. That followed the killing six months ago of a psychiatric technician who was attacked by a patient, another patient attacked a therapist in December, and now this incident on Monday.

It’s unclear how the patient died. An autopsy is scheduled for Wednesday.

ABC7 attempted to reach the hospital for comment and were told to call back in the morning.

URL: http://abclocal.go.com/kgo/story?section=news/local/north_bay&id=8069772

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