Sunday, August 28, 2011

Insane Restrictions on Physical Control of Ultra-violent Mental Patients

The consequence is sever injuries to anyone who works in these facilities. Left wing ideologues in capital cities are using false or incomplete  data to support the elimination of restraints, or other physical measures of control of ultra-violent mental patients. Some have been expelled from Supermax prisons as unmanageable.

So what if a patient is going on a rampage in the TV lounge. Staff: well we clear the lounge until the patient is finished three hours later.

OK. What if the patient is choking another, and the other is turning blue? Then we do put our hands on him, and everyone has to lie on the report of the incident.

Why would irresponsible, slow witted, pro-criminal, biased, left wing extremist, state officials seek to go "restraint free?" What is the alternative to physical controls of ultra-violent mental patients? The answer is, more staffing. The main aim is government enlargement, and increased staffing and costs of these institutions. The money motivation makes the rules enactment one in bad faith, to make more money and expand the size of government.

"An Atascadero State Hospital psychiatric technician suffered head trauma and a fractured eye socket after a Wednesday night beating -- just one day after lawmakers convened in Sacramento to consider the violence plaguing the state's five psychiatric facilities and to try to come up with solutions, Sen. Sam Blakelee's office said today.

Blakeslee (R-San Luis Obispo) learned of the assault Thursday and has met with the hospital's  executive director for a briefing. His office also spoke to employee groups about the attack.
At Tuesday's hearing, Blakeslee had called on Department of Mental Health officials to expedite the creation of special units for the most violent patients and to send those who are too violent to treat to prison.
"The offender responsible for this attack had made explicit threats against this employee and had a well-established record of violence," Blakeslee said in a statement Friday. "This week’s assault underscores the urgent need for reforms to ensure the most dangerous offenders will be swiftly returned to a correctional facility once violent and assaultive behavior becomes evident.”

A statement provided by the Department of Mental Health to Blakeslee said only that the female employee was assaulted at 8 p.m. and hospitalized in moderate condition. A psychiatric patient was booked into the San Luis Obispo County jail on counts of battery using force likely to cause serious injury. The hospital has initiated a proceeding to have him returned to prison.

Blakeslee learned more during his meeting at Atascadero on Friday. According to chief of staff Christine Robertson, employee groups reported that the assailant had "made it known that his goal was to be returned to prison, so he had been engaged in threats and attacks" and had previously threatened the victim. The patient was in restraints and asked to go to the bathroom, where the psychiatric technician either "loosened or removed the restraint and with the free hand he beat her."

Tuesday's hearing touched on the need to distinguish between predatory violence that is intentional and violence spurred by psychosis-related delusions. Staff members have pushed for a more punitive approach toward those who knowingly commit violence. About 92% of the state's hospital patients have either been arrested or convicted of a crime related to their mental illness. Many are vulnerable and regularly victimized. Others, meanwhile, possess a "prison mentality" and are prone to prey on others."

Sunday, August 21, 2011

Coping with Plaintiff Expert Witnesses

Nice review of the subject at the above link.

"Most state medical boards have the authority to discipline doctors found to have provided unethical witness testimony, said Lisa Robin, chief advocacy officer of the Federation of State Medical Boards. However, each board's process of investigating complaints and enacting discipline differs. Whether states have jurisdiction to punish out-of-area doctors also varies, Robin said.
The American Academy of Emergency Medicine publishes expert witness testimony online.
In Mississippi, doctors from out of state who give deceptive testimony can be prohibited by court injunction from testifying in future cases. The state medical board also can revoke the licenses of doctors who provide false testimony and charge physicians up to $10,000 for investigating a case."

The litigation privilege will trump any licensing authority sanctions, and will be reversed by the courts. The courts want witnesses to be immune for their testimony, however false. This privilege is supported by the Supreme Court in a case where a police officer could not be sued for lying on the stand and sending an innocent defendant to prison for a few years.  Little hope for doctors if the immunity is that extreme and even covers the crime of perjury.

Doctors should still report unprofessional conduct to all the licensing boards of the witness. It is just a moral obligation, and a legal one in some states, where there is mandated reporting of unprofessional conduct. Take each shady statement, and report it to each board once a month, so that the h witness remains under investigation for years. I am not aware of any statute of limitations for licensing board reporting.

Some boards will reply that testifying at a malpractice trial is not an act of medicine. It most definitely is. It is an act of super-medicine. It tells the doctors of the state what the standard of due care in a medical matter is.

2) Most of the recourse against plaintiff experts has to be found inside the trial itself. Defense counsel has a conflict of interest making money from having a rial. So they will resists acting against plaintiff experts. One must hire a second private attorney to terrorize the insurance company lawyer into acting a bit different, attacking the expert and seeking to end the trial before it begins.

3) Disqualify the expert.

4) Find a false fact uttered by reading every word uttered by the expert. Demand a mistrial and all legal costs assessed to the personal assets of the expert. Opinion has the protection of the First Amendment. False testimony about facts is perjury and not privileged. For example, the expert claims to have read a document and has not. He claims to have researched an article and has not.

Rapid Change in Consciousness from Low Dose Tramadol

A patient did not take any prn Ativan that day, took half a tramadol 50 mg. for pain. She woke up chained in an ambulance with no recall of the following. She fell asleep, drifted into the grassy divider of a highway, and eventually came to a stop. Luckily, she did not cross into oncoming traffic. Police  arrived, she was in a rage and agitated. She had to be restrained and tied to the gurney. That is what she was told, because she has no recall prior to waking up in the ambulance ride. Most disturbing, this effect was not preceded by gradual sedation. It was sudden. Nothing could be done to prevent it, such as drive onto the shoulder of the road until it passed.

Next day, she tried this experiment,  at her house. She did not take any Ativan. She took 25 mg of Tramadol at the same time of day. Within a half hour, she was nodding off and could not be awakened by her family for an hour.

She then spoke to her mother. Mother had the exact same experience with tramadol. This sensitivity to this one drug runs in her family. Her other meds are at ordinary medium doses.

She is on an antidepressant, but had no evidence of a serotonin syndrome, nor of a seizure.

I suggested she get together with her prescribing doctor, get the ER records, and fill out an FDA Adverse event form.