Jury to decide fate of Calgary psychiatrist Aubrey Levin, accused of sexual assault

CALGARY – Jurors will be charged on Friday with determining a verdict in the trial of a Calgary psychiatrist accused of sexually assaulting several of his patients.

It has been over three months since the trial for Dr. Aubrey Levin began.

He’s facing ten counts of sexually abusing nine of his patients.

The Crown alleges the abuse took place over 11 years from 1999 to 2010, including some patients who were court-ordered to see Levin.

In his final arguments, Crown prosecutor Bill Wister told the jury the alleged victims were sitting ducks, and were the last people on earth a psychiatrist would expect to speak out.

During the trial, the jury viewed graphic video the chief complainant said was secretly recorded, showing allegedly inappropriate contact from Levin.

Source: Melissa Ramsay, “Jury to decide fate of Calgary psychiatrist accused of sexual assault,” Global News, January 25, 2013.

The man who took the video says he was assaulted by Levin numerous times during court-ordered counseling sessions.

Levin has said he was conducting an examination to check for sexual dysfunction.

The 73-year-old was found physically able to stand trial, but his lawyers argued that he has dementia and does not understand the justice system.

His defence lawyer Chris Archer has told the jury the nine men who accuse him of sexual assault are motivated by money and have fabricated their allegations.

Pig farmer sues Chinese government after being detained in psychiatric hospital

A COURT in northeast China has begun to hear a case in which a farmer is suing government departments in an eastern city, claiming they forced him into psychiatric hospital.

Liu Gang, who ran a pig farm in Linyi City in Shandong Province, said he was admitted to a hospital’s mental illness unit on September 19, 2008, reported the People’s Court in Beizhen City, Liaoning Province.

Liu, a native of Beizhen, had been trying to file a complaint over the sudden deaths of his pigs following epidemic control measures by local authorities, the court heard.

Liu said he was released from the hospital on October 8, 2008, but sent there again on January 6, 2009, after asking for an “explanation” from the bureau of complaints and civil affairs over the first admission. His second stay lasted 36 days.

On Friday, the defendant and plaintiff argued whether Liu’s personal freedom was illegally restricted and whether he suffered from mental illness. Both parties agreed for Liu to take psychiatric tests.

Source: “Pig farmer sues gov’t after forced into ‘psychiatric hospital’,” Sina, January 20, 2013.

NY psychiatrist Gino Grosso sentenced on controlled substance conviction

On July 3, 2012, psychiatrist Gino J. Grosso surrendered his license to the New York State Board for Professional Medical Conduct (BPMC), in response to a charge of professional misconduct. According to the BPMC’s statement of charges, on or about January 5, 2011, Grosso pleaded guilty to the felony of delivery of or possession with intent to deliver a controlled substance. He was sentence June 14, 2011 to no less than three nor more than 10 years in prison.

Psychiatrists charged, disciplined nationwide August-October 2012

On October 24, 2012, the Virginia Board of Medicine reprimanded psychiatrist Daniel Acosta. The Board’s Consent Order states that on March 13, 2012, the North Carolina Medical Board reprimanded Acosta and ordered that he attend continuing medical education on record keeping and prescribing, based on findings that Acosta’s diagnosis, treatment and documentation of six patients failed to conform to the standards of acceptable and prevailing medical practice.

On September 7, 2012, the Michigan Department of Licensing and Regulatory Affairs summarily suspended the license of psychiatrist Nan Beth Alt on charges of negligence, lack of good moral character, fraud or deceit in obtaining or attempting to obtain a third party reimbursement and allowing an unauthorized person to use her medical license. The complaint filed against Alt states that allowed her father, also a physician, to work out of her office and also wrote provided pre-signed prescriptions forms for him. The senior Alt’s medical license had previously been suspended.

On August 31, 2012, the Texas Medical Board ordered psychiatrist Robert Alan Woodward to pay an administrative penalty of $5,000 in addition to ordering him successfully complete at least eight hours of continuing medical education on the topic of risk management, among other terms and conditions. According to the Board’s report, this disciplinary action was the result of Woodward having failed to renew his controlled substance prescribing certificate when it expired in November 2010 and wrote more than 500 prescriptions for controlled substances before finally renewing it in March 2011.

On September 17, 2012, the Medical Board of California issued an Accusation against psychiatrist Lana Le Chabrier, relative to Le Chabrier’s criminal conviction. According to the Board’s document, on or about July 12, 2012, Le Chabrier was found guilty of health care fraud and conspiracy to commit health care fraud against the Medicare program. Le Chabrier was sentenced to six and a half years prison.

On or about October 18, 2012, Harvard psychiatrist David Herzog surrendered his licensed to the Massachusetts Board of Medicine. Herzog, who founded the Harris Center at Massachusetts General Hospital (an eating disorders center), was found to have engaged in sexual misconduct with a bulimic patient. Administrative findings describe and increasingly friendly relationship between Herzog and the patient, culminating in a sexual encounter in the patient’s home while her husband was away.

Precedent: Psychiatrist goes to prison following patient’s axe murder

MARSEILLES, France – A French psychiatrist whose patient hacked an elderly man to death was found guilty of manslaughter on Tuesday in a groundbreaking case that could affect the way patients are treated.

A court in Marseilles said Daniele Canarelli, 58, had committed a “grave error” by failing to recognize the public danger posed by Joel Gaillard, her patient of four years.

Gaillard hacked to death 80-year-old Germain Trabuc with an axe in March 2004 in Gap, in the Alps region of southeastern France, 20 days after fleeing a consultation with Canarelli at Marseilles’s Edouard Toulouse hospital.

Canarelli was handed a one-year prison sentence and ordered to pay 8,500 euros to the victim’s children, in the first case of its kind in France. Defense lawyers said the ruling would have serious repercussions for treatment of the mentally ill.

“If a psychiatrist lives in fear of being sentenced, it will have very real consequences and probably lead to harsher treatment of patients,” said Canarelli’s lawyer, Sylvain Pontier.

The court said Canarelli should have requested Gaillard be placed in a specialized medical unit or referred him to another medical team, as one of her colleagues suggested. Her stubborn refusal had equated to a form of “blindness”, the court president Fabrice Castoldi said.

Gaillard had already been forcibly committed to a secure hospital on several occasions for a series of increasingly dangerous incidents.

The victim’s son, Michel Trabuc, said he hoped the case would set a legal precedent.

“There’s no such thing as zero risk, but I hope this will move psychiatry forward and, above all, that it will never happen again,” he said.

Gaillard was not held responsible for his actions and was freed under medical supervision.

Source: Jean-François Rosnoblet, Vicky Buffery and Alison Williams, “French psychiatrist sentenced after patient commits murder,”
Reuters, December 18, 2012.

Study concludes that psychiatrists almost four times as likely to be sanctioned for sexual misconduct

The new analysis of a decade of discipline cases across Canada more than confirmed anecdotal evidence and a previous study that suggested a problem with psychiatry, said Dr. Chaim Bell of Toronto’s Mt. Sinai Hospital, who co-authored the paper.

Psychiatrists are twice as likely as other Canadian doctors to face professional discipline generally and almost four times as apt to be sanctioned for sexual misconduct, concludes a new study that underscores long-held concerns about the speciality.

Experts blame the problem in part on psychiatrists’ unusually close and long relationships with their patients, compared to surgeons and some other specialists who often have relatively brief contact with the people they treat.

Past research has suggested many of the wayward therapists may also be “lovesick,” middle-aged men in isolated practices who fall for younger women, the study notes.

Regardless, the new analysis of a decade of discipline cases across Canada more than confirmed anecdotal evidence and a previous study that suggested a problem with psychiatry, said Dr. Chaim Bell of Toronto’s Mt. Sinai Hospital, who co-authored the paper.

“This is surprising in how consistent it is across the various provinces, how consistent it is in different years, and how consistent it is with penalties and fines,” he said. “It’s also consistent with the sort of sensational, one-type anecdotal coverage you might get…. The [discipline case] that gets the front page is often the psychiatrist.”

Just this month, in fact, at least two psychiatrists have been in the news for sexual-abuse allegations. A London doctor under investigation by the Ontario College of Physicians and Surgeons for allegedly masturbating and inappropriately videotaping female patients was charged by police with sexual assault and voyeurism. In Calgary, meanwhile, a psychiatrist is being tried on charges of sexually assaulting 10 male patients.

Dr. Bell, an internal-medicine specialist, stressed that it is still a small percentage of psychiatrists — about two per thousand — who get in trouble with their regulatory colleges. Given the “catastrophic” effect even rare cases of misconduct can have on patients and the public trust, however, psychiatry must do more to curb wrongdoing, the study’s authors say.

At the same time, the average psychiatrist who faced discipline over the 10-year study period had been practising for more than 30 years, perhaps reflecting a shrinking generation of practitioner, said Dr. Molyn Leszcz, Mt. Sinai’s chief of psychiatry.

Younger psychiatrists have been exposed to training on appropriate boundaries with patients, are more conscientious about their own emotional health and actually do their jobs differently, said Dr. Leszcz, who was not involved in the study. They are more likely to practise with groups of other doctors and spend less time in one-on-one psychotherapy sessions, he said.

“If you sit in your office and experience the kinds of strong feelings that get generated in psychotherapy all the time, in isolation, then it becomes harder to maintain professional perspective,” said Dr. Leszcz.

Still, the results from Dr. Bell’s study are “disappointing” in light of the measures taken to combat sexual abuse, said Dr. Donald Addington, chair of the Canadian Psychiatric Association.

“This kind of report makes us think about ‘What more could be done?’ and at this point, we don’t have a particular new plan or direction,” said the University of Calgary professor.

Dr. Bell said the regulatory colleges in each province do little tracking themselves of trends in discipline, so he and his colleagues developed a database of physicians punished for wrongdoing from 2000 to 2009, a total of just over 600 cases.

Psychiatrists made up 14% of that number, twice their percentage in the medical profession, concluded the study, just published in the journal Plos One. They were 3.62 times more likely than other physicians to be found guilty of sexual abuse of patients, had 2.32 times more chance of being convicted of fraud-related discipline offences, and were three times as apt to be found guilty of unprofessional conduct, the paper said.

Little research has been done on psychiatrists who “violate boundaries” with patients, but one 1989 study suggested a small number are actually psychotic, a somewhat larger group show antisocial or exploitative behaviour, and the largest category are the “lovesick” — typically neurotic, socially isolated middle-aged men who fall for much younger patients.

A 1997 Canadian study that followed a group of new psychiatrists over time concluded that the two who were eventually convicted of sexual abusing patients had identifiable personality problems even while still in training.

That raises the “ethically challenging” prospect of screening medical students for sexually exploitative tendencies before they are assigned to specialty training, the new study noted.

It is simply unclear, meanwhile, why a disproportionate number of psychiatrists are found guilty of fraud-related discipline charges, he said.

Source: Tom Blackwell, “Psychiatrists four times as likely as other Canadian doctors to be disciplined for sexual misconduct: study,” National Post, December 6, 2012.

Psychiatrist pays Tennessee $325,000 for alleged overbilled psychotherapy services

A Madison psychiatrist will pay the State of Tennessee more than $325,000 for allegedly overbilling TennCare patients for visits, Tennessee Attorney General Bob Cooper announced today.

Named in the agreement is psychiatrist A.K.M. Fakhruddin who is alleged to have overbilled patients for psychotherapy visits. Such practices are illegal under the Tennessee Medicaid False Claims Act. The settlement, which included substantial penalties, represents nearly three times the amount Fakhruddin is alleged to have taken from the program.

An investigation by the TennCare Provider Fraud Task Force revealed that from May 2007 to December 2010, Dr. Fakhruddin billed for extensive 45-50 minute psychotherapy visits when in most cases he was performing brief medication management services with minimal psychotherapy.

“In a few instances, he billed for more than fifteen hours in a day when the actual time spent with patients was a fraction of that amount,” Attorney General Cooper said. “The Task Force takes very seriously the misuse of taxpayer dollars and will continue to work diligently to end such practices. “

The fraud concerned billings for over 150 patients. The Task Force includes the Attorney General’s Office, TennCare, the Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit and the Office of Inspector General. It is charged with pursuing fraud by any TennCare provider. General Cooper noted, “The Task Force concentrates on every aspect of Medicaid Fraud, which includes not only physicians and drug companies but also mental health services.”

Inspector General Deborah Faulkner stated, “The State of Tennessee is aggressively investigating TennCare fraud and abuse from every angle by working in unison to achieve the overarching goal of protecting taxpayer resources. The cooperation between our Offices is an example of a successful collaboration to stop TennCare fraud.”

Dr. Fakhruddin, who intends to retire and sell his practice, has denied any wrongdoing. There were no allegations of patient harm.

Source: “State Cracks Down on Psychotherapist for Overbilling TennCare,” press release of the Tennessee Attorney General, December 3, 2012.

Psychiatrist Stephen Merritt Raffle reprimanded for discussing real estate deals with patient during sessions

MARIN COUNTY — A Kentfield psychiatrist was reprimanded by state regulators on allegations he used a patient’s therapy sessions to talk about the real estate business, the state medical board said.

Dr. Stephen Merritt Raffle was “grossly negligent” and committed “multiple boundary violations” by discussing his business experience and referring the patient to real estate lawyers and lenders, according to a filing by Linda Whitney, executive director of the board.

The board also alleged that Raffle failed to create or maintain therapy records over a period of more than three years, covering about 78 sessions.

Raffle was ordered to take courses in “professional boundaries,” medical record keeping and professionalism, the state board said. If he fails to complete the programs, he will have to end his practice.

The state medical board’s website describes a public reprimand as a disciplinary action for a “minor violation.” Raffle, who has been licensed since 1969, has no other disciplinary record.

Raffle had no comment Friday, his office said.

The patient started seeing Raffle in the aftermath of his father’s death and a probate dispute with his uncle. After the patient received counseling for that matter, he alleged that Raffle invited him to continue therapy to receive “financial advice” to help him “get ahead,” according to the board’s filings.

The patient alleged that the therapy, which continued until 2008, “consisted mainly of discussions about real estate,” according to the board’s filing.

In 2004, the patient bought a five-unit apartment building, intending to reside in one unit and live off the rental income from the others. Raffle allegedly advised the patient to convert them to condos and directed him to a lender and an attorney.

The patient said he ran out of money before the project was completed, got more money from the same lender, and ran out of money again, the medical board said. When the patient could not get another loan, Raffle allegedly recommended that the patient sign the property over to him and rent back one of the units.

The patient said he declined and stopped seeing Raffle. The medical board, represented by the state Attorney General’s Office, filed the accusation in July 2011. Raffle settled by stipulating to a reprimand, and it took effect on Friday.

In addition to his clinical practice, Raffle is a litigation consultant and has taught at the University of California at San Francisco, and the University of California Hastings College of the Law, according to his website.

Source: Gary Klien, “Marin County psychiatrist disciplined over alleged real-estate talks with patient,” Marin Independent Journal, December 3, 2012.

Convicted psychiatrist seeks to avoid prison; will be sentenced Dec. 7

His lawyer is asking that an 82-year-old New City psychiatrist who admitted in June to illegally distributing prescription drugs be sentenced to a fine and community service rather than prison time.

Aristide Esser faces up to 20 years in federal prison when he is sentenced Dec. 7 by Judge Kenneth M. Karas in U.S. District Court in White Plains.

John E. Finnegan, a lawyer for Esser, said in a sentencing memorandum filed Friday that the psychiatrist had a distinguished career before it was derailed in 2011 by at least four incidents where Esser illegally prescribed Seconal, a sedative, to cooperating witnesses. Esser’s conduct, Finnegan said, was illegal but did not fit the pattern of recent arrests of doctors, many of whom are accused of operating so-called “pill mills.”

“He was not engaged in ‘drug dealing’ in the traditional sense of the term, involving large-scale distribution for profit,” Finnegan wrote in court papers, before writing that some of Esser’s prescriptions resulted from patients’ “skillful manipulations and persistence.”

Prosecutors, meanwhile, have said that Esser told the cooperating witness that he would “gladly medicate” the witness’s friends, should they also need prescriptions.

Prosecutors have said that Esser’s 2011 conduct is just the latest in a string of incidents regarding Esser’s alleged overprescription of drugs to patients. Esser was previously ordered to stop prescribing opiates after a 2001 investigation by the state Department of Health, which accused him of giving opiates to substance abusers without proper evaluation or monitoring, according to court papers.

In the sentencing memorandum, Finnegan said Esser grew up in Indonesia during the Japanese occupation in World War II. Esser’s father and uncle were executed by the Japanese. Esser moved to Holland in 1946, before eventually going to medical school and, in 1961, coming to the United States to serve as a research fellow at Yale University. He later moved to Rockland County, where he practiced psychiatry for decades.

Seconal was widely used in the 1960s and 1970s but has been less popular among recreational users in recent years. A parade of famous musicians, artists, writers, and others were said to have used or abused Seconal, including Tennessee Williams, Judy Garland, and Jimi Hendrix. Garland died June 22, 1969, after a suspected Seconal overdose.

Source: Erik Shilling, “New City psychiatrist, 82, seeks to avoid prison in drug case,” The Journal News, November 26, 2012.

State halts Medicaid payments to psychiatrist Michael Reinstein; federal suit fraud, kickback allegations

The Illinois Department of Healthcare and Family Services has suspended Medicaid payments to a controversial Chicago psychiatrist who the federal government says fraudulently prescribed antipsychotic medication to thousands of mentally ill nursing home patients.

The action means that Dr. Michael J. Reinstein, also accused in a federal lawsuit of accepting kickbacks from drug companies, will be prohibited from billing Medicaid, and that any unprocessed bills already submitted will not be paid, said Bradley Hart, Medicaid inspector general.

Hart said the 180-day suspension could be extended pending the status of the federal lawsuit, which was filed last week.

Meanwhile, another state agency, the Illinois Department of Financial and Professional Regulation, has filed a formal complaint against Reinstein that mirrors the federal accusations and could lead to disciplinary action on his medical license. A preliminary hearing is set for Dec. 17.

The two-count complaint alleges that Reinstein “routinely and continuously” prescribed to elderly patients various psychiatric medications, including clozapine, also known by its brand name, Clozaril, despite the risk of potentially life-threatening side effects, including seizures and death.

The “respondent knew and/or should have known that clozapine is considered to be a drug of last resort for elderly patients,” the complaint says.

The complaint also alleges that Reinstein prescribed the treatment in exchange for financial compensation from IVAX, the manufacturer of generic clozapine, and Teva Pharmaceutical Industries Ltd., the company that IVAX later merged into.

Reached by phone Monday, Reinstein, 69, said he was unaware of the payment suspension and couldn’t comment on it. But he said he prescribed the drug appropriately.

“I feel my treatment with clozapine was justified,” he said. “I think for the severely mentally ill population that I treat, the patients I use clozapine with, it was the best choice. I am confident that I will be vindicated.”

He said he will borrow money if necessary to continue his medical practice, which includes working at four hospitals, 20 nursing homes and his office in the Uptown area.

Acting U.S. Attorney Gary Shapiro said last week that the federal lawsuit filed against Reinstein represented “the largest civil case alleging prescription medication fraud against an individual ever brought in Chicago.”

A joint 2009 investigation by the Tribune and ProPublica, a nonprofit investigative journalism group, revealed Reinstein’s unusually heavy reliance on clozapine, which has been linked to at least three deaths. In 2007 he wrote more prescriptions for clozapine than all the doctors in Texas combined, the investigation found. The Illinois Department of Financial and Professional Regulation mentioned the series in its complaint.

In their lawsuit, federal authorities alleged that Reinstein submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he had prescribed based on the kickbacks he received from pharmaceutical companies instead of the medical needs of his patients.

He also allegedly submitted 50,000 more claims to Medicare and Medicaid in which he falsely stated he had properly monitored the conditions of his patients at more than 30 area nursing homes and long-term care facilities, according to the lawsuit.

The suit seeks triple damages under the False Claims Act as well as hefty civil penalties for each of the tens of thousands of alleged false claims — a total that could easily reach millions of dollars if authorities prove the allegations against Reinstein.

Federal authorities said they are continuing to investigate Reinstein. Hart said his department is assisting them, including calculating the amount of payments for which they may seek restitution.

Source: Deborah L. Shelton, “Watchdog Update: Medicaid payments to psychiatrist halted,” Chicago Tribune, November 20, 2012.