Psych Crime Reporter

February 17, 2011

Official report seeks to shut down psychiatric “house of horrors” in Mumbai

The 110-year-old Masina Hospital – which boasts of one of the city’s foremost psychiatry wards – has been slammed by the Directorate of Health Services (DHS) for rampant violations of the Mental Health Act of 1987.

The hospital has been asked to put its act together or face a shutdown.

A report filed by the five-member committee, appointed by DHS, states that the hospital has been illegally detaining patients in its psychiatry ward and forcefully administering psychotropic drugs to the detainees.

The head of the psychiatry ward, Dr. Yusuf Matcheswala, however is of the opinion that these are only “minor drawbacks,” which do not warrant a shutdown or similar punitive measures.

The matter came to light after Kemp’s Corner resident Pushpa Tolani filed a complaint with the Maharashtra Human Rights Commission (MHRC) claiming that her friend Neela Shete was detained in the hospital illegally.

Tolani in her complaint pointed out that many other patients like Shete were detained without a reception order from the district magistrate – a mandate under the Mental Health Act.

Shete, 55, a resident of Altamount Road was admitted in July. She was discharged two months later. “The doctors’ claim that she had schizophrenia may or may not be true. However, they cannot detain any adult for such a long time without a reception order,” said Tolani, adding that Shete has been untraceable since her discharge. “They have similarly detained many patients without their consent and in all possibility, they are administering drugs which may be worsening their condition,” she alleged.

Dr. Matcheswala however rubbished these claims saying, “Shete was my patient for the last three years. Her admission for two months was also voluntary and we had not detained her illegally.” He added that he has not heard from Shete since September.

Meanwhile, the MHRC refused to take Tolani’s allegations lightly and directed the DHS to file a detailed report after an investigation. “After surveying the hospital and cross checking all the allegations we learnt that about 20 more patients were detained illegally at the hospital.

They were administered treatment which has been banned, and their relatives were overcharged. Often the patients are being drugged even when it was not required,” said Dr. Sanjay Kumavat, who is heading the DHS committee.

The committee including Kumavat, advocate Chaya Haldankar, clinical psychologist Dr. Vinayak Mahajan and psychiatrist Dr. Geeta Joshi personally met these patients.

While Dr. Matcheswala said that he was aware of the enquiry, and vowed to “rectify” the “shortcomings” once the report from DHS was made available to him, Dr. Kumawat and the investigating committee were in no mood to for any leniency.

Psychiatrist Dr Yusuf Matcheswala

“If the hospital fails to straighten up in the stipulated time, their licence will be revoked and the mental health facility will be shut down. The matter is also under the purview of human rights commission. If they are found guilty of violation of the act, as per IPC they can face imprisonment up to five years and cancellation of licence,” said Kumavat.

“Ours is the only psychiatric ward in the city. We cannot close down because of such minor drawbacks,” said a belligerent Dr. Matcheswala.

What’s ailing Masina hospital

♦ Detaining patients without consent: “Ideally a patient can come voluntarily or following a court order. However, patients here were brought in a van at relatives’ request. There are cases of relatives sending patients away due to vested interest,” said Kumavat, and consent taken later.

♦ Unqualified staff, inadequate facilities: The report says the hospital has few psychiatric nurses and other professionals. Despite a 40-bed licence, some 100 patients are kept without permission.

♦ Forcing unnecessary therapies, including shock therapy: Patients are administered treatment banned long ago.  Shock treatment is often used despite use of tranquillisers. One patient is given 35 sessions of Transcranial Magnetic Stimulation, which is unnecessary.  “As patients are unaware, the hospital administers almost all non required treatment and makes money for itself and pharma firms, by extending their stay,” said Dr Vinayak Mahajan, committee member. “We have prescriptions of unwanted medicines,” he said.

♦ Patients seldom rehabilitated: Hardly any patients are being rehabilitated. The hospital only concentrates on active psychiatric cases. They are not maintaining patient records and case papers.

Source: Sobiya Moghul and Jyoti Shelar, “City’s foremost mental hospital uses banned therapies, detains patients illegally,” Ahmedabad Mirror, January 4, 2011.

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October 12, 2010

State seeking to revoke psychiatrist’s license for incompetence, gross negligence, false claims

On September 22, 2010, the Medical Board of California issued an Accusation and Petition to Revoke Probation on psychiatrist Joseph Ling-Hang Chan and is seeking to revoke his license, among other disciplinary measures.

The Board issued an Order on January 12, 2009, suspending Chan for 30 days and placing him on probation for seven years for gross negligence, repeated acts of negligence, incompetence and excessive prescribing involving seven patients, most of whom were elderly. The Order details how Chan prescribed multiple atypical antipsychotic drugs (Seroquel, Clozaril, etc.) in excessive amounts and failed to maintain appropriate medical records, failed to order appropriate lab tests (specifically with regard to the use of Clozaril) and/or failed to maintain adequate and appropriate records of the results of such tests.

A typical scenario in the January 2009 Order: Chan maintained a 68-year-old patient on Prolixin and Zyprexa (both atypical antipsychotics), among other drugs, and noted in the chart that he would taper the patient off of Prolixin and keep him on Zyprexa, but that did not actually occur for four months.  In another entry, Chan wrote that he would “clean up Prolixin when [the patient] is stable.” That note was repeated verbatim in the patient’s record for five consecutive months and then was dropped with no explanation.  The notes don’t explain why Chan intended to cross-taper the patient from one drug to the other or why it was not carried out and the records do not provide justification for maintaining the patient on excessive doses of the two drugs.  The records show that shortly after, Chan added an additional antipsychotic, Seroquel, the patient’s regimen, but there was no rationale in the patient’s records for this addition and there was no justification noted when the dosage was increased.

In one incident, Chan continued to submit claims for payment of service for nine consecutive months after the patient died.

Additionally, the Order noted that Chan’s patient records in general were not adequate or accurate and that he submitted false billings to public heath plans (Medicare and Medi-Cal).  Specifically, he routinely failed to appropriately document patients’ medications; his rationale for treatment with multiple antipsychotic agents; reasons for making (or failing to make) medication changes; review of laboratory test results; follow up on drug side effects and his communications with the patients’ other health care providers.  Additionally, Chan’s patient records for numerous visits were identical or nearly identical for extended periods; contained factual errors and were missing documentation for numerous months during his care of multiple patients.

Lastly, Chan submitted inaccurate or false health care claims to state and federal health plans (including Medicare and Medi-Cal) for services he had not provided.  In one incident, Chan continued to submit claims for payment of service for nine consecutive months after the patient died.

The Board’s current Accusation and Petition to Revoke is based on Chan’s identical or similar treatment of five additional patients, as well as his failure to consult the patients’ prior medical records and filing false documents, among other things.

The Board noted that “despite remedial clinical education,” Chan “demonstrated little understanding of the purpose of medical records or the importance of maintaining adequate and accurate records; rather, [he] stated that he made trivial changes in his records from visit to visit for the sole purpose of deflecting criticism.”  Additionally, with regard to the false billings, the Board noted that Chan “routinely prepared medical records and bills for services…with the intent to receive compensation for services not rendered” and “admitted to excessive billing, which he justified on the basis that he was not paid enough for his services….”

Source: Accusation and Petition to Revoke Probation in the Matter of the Accusation Against Joseph Ling-Hang Chan, M.D., Physician and Surgeon certificate F50691, Case Nos. D1-2006-174722 and 03-2008-193948 and Stipulated Settlement and Disciplinary Order in the Matter of the Accusation Against Joseph Ling-Hang Chan, M.D., Physician and Surgeon certificate F50691, Case No. 03-2008-193948, Medical Board of California.

This information was used with permission of the Citizens Commission on Human Rights International.

November 26, 2009

Did your psychiatrist fail to warn you of the possibility of developing repetitive and disfiguring involuntary facial or body movements before prescribing you an antipsychotic drug?

If you answered “yes” and you are experiencing such movements, you may have the basis for a lawsuit.

Psychiatrists are required (as are all health care practitioners) to ensure that patients fully understand the potential effects of any drug they prescribe—the bad effects as well as any good ones.  When failure to do so results in harm to a patient, it may be grounds for legal action. 

Tardive dyskinesia (TD) is a movement disorder caused by prolonged use of antipsychotic drugs (such as Haldol, Risperdal and others).  The word “tardive” means “delayed” or “late developing” and refers to the observation that this disorder begins, not right away, but after months or years of being on a drug or drugs in this class.  The word ”dyskinesia” means “abnormal movements.”

TD is characterized by involuntary movements including:

  • lip smacking
  • blinking
  • raising eyebrows
  • tongue twitching and protrusion
  • puffing of cheeks
  • puckering of lips
  • toe tapping
  • jerking or rhythmic repetitive motions of the fingers, hands, arms, legs, and/or torso

Sometimes these are barely noticeable to an outside observer.  Sometimes the disorder is severe and disabling.

While the condition has been known in some cases to stop with the cessation of the drug1, it has also been known to commence with cessation of the drug.  The symptoms are otherwise irreversible; there is no known cure.

The risk of TD appears to be greater in elderly patients on high doses of the drugs, especially females.2

Types of antipsychotics

Antipsychotic drugs fall into two classes: “typical” and “atypical.”

Typicals are those that were introduced as far back as the early 1950s and include Haldol, Prolixin, Stelazine and Thorazine.

Atypicals were introduced in the early 1990s and include Abilify, Geodon, Risperdal, Seroquel and Zyprexa.  They are called “atypical” because they are chemically different from the earlier (“typical”) kind.

TD statistics

The U.S. Food and Drug Administration (FDA) receives hundreds of TD and TD-related adverse event reports every year for antipsychotics.  For instance, between 2004 and 2006, the FDA received 204 complaints on Abilify and 104 on Geodon.3 The drug adverse event reports that the FDA receives represent as little as one percent of all such adverse events.4 Thus, the actual number of TD-related events could be in the thousands.

Legal remedy

A patient who develops TD can sue the treating psychiatrist for malpractice on one or more points:

  • Battery or Negligence, for prescribing the drug without any consent (battery) or prescribing it without obtaining the patient’s full informed consent, i.e., failure to ensure that the patient fully understood potential side effects, including the incidence of TD (negligence).  Physicians are required to ensure that patients understand benefits and liabilities of 1) a proposed treatment; 2) any alternative treatments and 3) no treatment.
  • Negligence, for the psychiatrist’s inappropriate assessment, incomplete medical or psychiatric history, deficient medical examination, failure to perform laboratory examination or misdiagnosis.  Negligent malpractice liability can also be based on lack of indication for the drug; failure to monitor and care for side effects, excessive duration of treatment and dosage or failure to consult with another physician.
  • Patients who have been committed to state hospitals may have a claim for violation of their Civil Rights under the 8th and 14th Amendments to the Constitution.  Under the Civil Rights Act, the allegation would be that the treating psychiatrist relying on the authority of state law, deprived a patient of his constitutional rights by providing psychiatric assessment and treatment to the patient and failed to obtain appropriate consent to administer antipsychotic drugs.
  • A patient who develops TD after antipsychotic treatment in prison or a state mental institution can also file a federal Civil Rights action on the basis that the psychiatrist was “deliberately indifferent” to the patient’s condition.

Cases

There is considerable case law on the books to support TD-related malpractice actions.  Patients routinely prevail in such cases:

Gatling v. Perna: The patient alleged her treating psychiatrist did not obtain her informed consent in 1980 for a five-year course of antipsychotics, failed to refer her to a neurologist after she developed TD and concealed his malpractice by reassuring her that her TD was not due to the drug.  Though the trial court dismissed the case due to expiration of the statute of limitations, the Texas Court of Appeals reversed the decision and sent the case back, critical of the notion that the psychiatrist may have fraudulently concealed the patient’s true condition with his reassurances—circumstances which would have kept the statute from expiring.5

Hedin v. United States: This 1985 case involved a veteran who was prescribed Thorazine for four years for alcohol abuse in a Veterans Administration hospital.  The prescribing doctor noted the patient had developed TD and admitted his negligence in prescribing excessive amounts of the drug without proper supervision.  A jury awarded the patient $2,200,000.6

Accardo v. Cenac: In March 1997, a Louisiana jury awarded homemaker Lou Accardo $675,000 in damages against psychiatrist Louis Cenac, who prescribed her the antipsychotic Prolixin for six years, resulting in TD.  Cenac’s defense, that Accardo was not compliant with treatment, was undermined by the fact that his file on Accardo contained billing records for monthly injections of the drug but no corresponding clinical progress notes, hence failure to monitor Accardo’s condition.  Accardo also alleged Cenac did not properly diagnose her and did not obtain her informed consent for the drug.7

Weaver v. Myers: On October 15, 2001, a Rhode Island jury found in favor of a 26-year-old mildly retarded young man whose mother contended that her son’s psychiatrist had, without her consent, put him on an antipsychotic. He subsequently suffered TD, which the psychiatrist recognized but he neither informed the mother nor removed the man from the drug (he prescribed an additional drug to counter the effects). The jury determined that the psychiatrist was negligent and awarded the plaintiff the sum of $1,500,000 plus interest.8

Hamel v. Jaffe: In mid-June 2002, a Hampden (Massachusetts) Superior Court found psychiatrist Kenneth Jaffe negligent in the care and treatment of Joan Hamel, to whom he prescribed the antipsychotic Mellaril for several years, which caused her to develop TD.  Hamel’s lawsuit stated that she was never informed of the potential risks associated with use of the drug and that Jaffe did not monitor her while she was on the drug. The jury awarded her $500,000 in damages.9

Jones v. Margolis: In November 2005, a Virginia woman was awarded $1.6 million against her physician.  The patient had been on the typical antipsychotic Triavil starting in 1982 and took it until her prescribing physician died in 1997.  Her new doctor continued her on the same regimen and in 2003 she developed TD.  The basis of her suit was misdiagnosis, failure to monitor and failure to obtain full informed consent.10

Conclusion

If you are suffering from disfiguring involuntary movements and are taking or have taken a prescribed antipsychotic drug, you may have the basis for a malpractice lawsuit.  A personal injury attorney or law firm can review your case and make this determination.

For more information, please contact Steve Wagner, Director of Litigation, Citizens Commission on Human Rights, at swagner@cchr.org

1 Spivey v. U.S. and Dept. of the Navy, 912 F. 2d 80 (United States Court of Appeals for the Fourth Circuit 1990).

2 Physicians Desk Reference, Edition 52, 1998, pg. 1512-13, 1999

3 Decoded FDA MedWatch database for 2004-2006, as posted at http://www.cchrint.org.

4 “Psychiatric Drugs: Chemical Warfare on Humans—interview with Robert Whitaker,” International Center for the Study of Psychiatry and Psychology, October 14, 2005.

5 Gatling v. Perna, 788 S.W. 2d 44 (Court of Appeals of Texas, 1990).

6 Hedin v. U.S., Number 5-83 CIV 3 (D. Minn) (1985).

7 Accardo v. Cenac, Case No. 350, 125 Div. “F,” March 16, 1997, as published by Verdicts, Settlements and Tactics, July 1997.

8 New England Jury Verdict Review & Analysis, Weaver vs. Myers, case #98-2687,October 15, 2001; April 2002.

9 “Jury awards woman $500,000 in lawsuit,” Union News (Springfield, MA), June 26, 2002.

10 “Tappahannock woman awarded $1.6 million for medical malpractice,” Virginia Lawyers Weekly, November 28, 2005.

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