Definition of Child Abuse Presentation for Delaware Health Licensees

Delaware Child Abuse Presentation

Here.

After Every Adverse Communication from a Health Plan

After every adverse decision or letter from a Health Plan, a letter of complaint about the Medical Director should be sent to the licensing board. Let them spend their time being investigated, and their money hiring lawyers. As they make it tough to do our jobs, so should we return the favor. Here is an example.

State Board of Medicine
P.O. Box 2649, Harrisburg, PA 17105-2649
Phone:             (717) 783-1400      
Fax: (717) 787-7769
ST-MEDICINE@pa.gov

RE: Unprofessional Conduct; X, MD; Medical Director,
Y Health Plan,
Dear Doctor:
I enclose a copy of a letter from Dr. X. I request that it be investigated for its unprofessional conduct. The blacked out areas have a single patient name. General opinion, commentary, and criticism have First Amendment immunity. This letter’s specific demands, criticisms, etc., represent the practice of medicine, because they are about a specific patient. They are therefore under your jurisdiction.

1) Y is a quasi-governmental organization with the ability to punish doctors. Its actions require a fair hearing. That was not granted nor even offered.

2) I believe Dr. X is not a qualified psychiatrist. He is therefore criticizing doctors outside his scope of knowledge or experience, two psychiatrists. I am board-certified in psychiatry. The Mcare Act requires that any governmental medical action be based on the opinion of an expert with qualifications equal to mine. This letter violates that statute.

3) Assume nothing was wrong with the procedure of Y. This doctor is still giving specific, technical, medical advice about a patient he has never met, nor whose clinical record he has reviewed.

4) His allegation of multiple prescribers of a psychotropic drug over 45 days fails to acknowledge that Dr. Z and I work for the same clinic. We are providing coverage for each other, using the same facility, reviewing the same chart, and seeing the patient when follow up visits are due. There is therefore good continuity of care, not multiple, unrelated prescribers. Clozapine is prescribed to patients who have failed to respond to multiple neuroleptic tranquilizers, and remain dangerous to themselves and to others. Not seeing such patients regularly is substandard care. He is also receiving Seroquel, to reduce the dose of required clozapine, a desirable goal given the side effects of this medication.

Weasel clauses in the standard insert do not detract from the seriousness of the allegation of medical mismanagement being made by this quasi-governmental organization.

Sincerely Yours,

David Behar, M.D.

Request for Advisory Opinions Sent to Licensing Boards

Sent to three licensing boards. 

I am licensed in medicine by your board. I request advisory opinions on the following scenarios with patients. To make things easier for you, I request that you rate the conduct described as unprofessional (U) or acceptable legally and regulatorily (A). You should expect that any opinion you send will be shared with others.

1) A child patient has behaved well with parent earlier, and during an exam. Doctor gives him a lollipop, saying, “This is for your good behavior today.” The cost of the lollipop is 50 cents.

2) A state mental hospital doctor pays an eager mental patient $10 for washing his car, while the car is in the state hospital parking lot, during work hours. Both parties are satisfied by the result.

3) Patients in a program are raising money for an activity. They organize a bake sale or a car wash. A doctor who works there pays $100 for a cake with a $5 charge tag, or a car wash costing $10.

4) A doctor needs computer services. A current patient is unemployed, and desperate for any income. The doctor pays his full fee, for a contract worth $10,000, mutually benefitting both parties. There is no contract dispute, where abuse of private knowledge can be used.

5) Same as 4), but there is a private, not a public contract dispute. The doctor uses personal knowledge about the weak spots of the patient to bully a favorable settlement from the patient.

6) A doctor “friends” a patient on Facebook.

7) As a Facebook “friend,” he sees messages on the page of the patient that he has begun drinking alcohol again, and stopped his blood pressure medication. The patient does not reveal these changes, actually denies them,  during a routine visit to the doctor. The doctor confronts and berates the patient (politely, yet firmly) about non-adherence to treatment. This is a reverse scenario as a violation of confidential health information. It uses public information in a private medical encounter.

8) As a Facebook friend, the doctor sees the patient plans to commit suicide or to kill his parents. The patient also says, he has collected a number of working guns. These intentions are denied in medical follow up sessions. Is there a duty to warn under the Tarasoff doctrine? Again this is the use of public information, superceding confidential denials during medical visits in the office.

9) The doctor and a patient fall in love. The doctor refers the patient to another doctor in the same specialty. They have sex, and eventually get divorced from their respective spouses and marry each other. (Please, review this question in light of two cases, Lawrence v Texas at the Supreme Court of the US, and Long v Ostroff decided at the Pennsylvania Superior Court).

Wrongfulness of Lawyer Licensing, Discipline, and Self-Regulation

The current arrangement of lawyer licensing and discipline violates the separation of powers, and is unconstitutional. It is not even rational, since no group of human beings has ever properly regulated itself in the history of mankind. The results are unfair self-dealt immunities, and countless virtual self-dealt immunities.

There are countless statutorily enumerated duties to the adverse third party in the Rules of Conduct, of Evidence, of Civil and of Criminal Procedure, not to mention case law over 1000 years. Yet, the lawyer is totally immune from liability for damage done to the adverse third party by misconduct. He is almost 99% immune from legal malpractice from his own client. The victim of malpractice must win a double verdict, that malpractice and damage took place, and second that he would have won the original case but for that lawyer malpractice. Next, he must prove that the original defendant was not judgment proof, and that he could have collected from the original defendant. Lastly, he must overcome the defense of the litigation privilege, where faulty judgment is privileged.

If liability is a substitute for violence, then violence against lawyers, and judges has full moral intellectual, and policy justification.

Next, there is no recourse for the public at the licensing level. Almost no civilian complaint is ever investigated properly nor taken seriously. Mostly complaints from judges are.

Writing the The Rules of Conduct is a legislative act. Yet it is done by the Supreme Court of a state. It often plagiarizes these rules from a professional society, the ABA, whose aim is to promote the interest of the lawyer, and not that of the public.

Next, a self-styled prosecutor investigates and prosecutes complaints against the lawyer. That is an executive function. Yet, the Disciplinary Counsel is an employee of the Supreme Court, and claims onto itself all discretions and immunities of a prosecutor, despite not being a real one.

Lastly, the Supreme Court of a state listens to the Disciplinary Counsel's case, the case of its own employee, and a person well know to the court. It then considers the arguments of an outside defense counsel. It is likely to favor which side, that of it s own employee, using all the buzz words provided by the court over time, or that of an argumentative stranger? So the procedural due process right to a fair hearing of the accused lawyer is brazenly violated.

Recovery Movement

Recently, a local agency was forced to adopt new Mission Statement, Philosophy Declaration in order to keep its referrals and public funding. Many other agencies have been forced to as well by government funding sources. Progress toward recovery is also expected in the documentation, so staff is forced to lie. Say a patient has not spoken in group for 6 months in a partial program, that is not progress toward recovery. So staff has to make stuff up about his improvement.

To argue by analogy, my agency treats paralyzed people. Could the goal not be adaptation to their condition, teaching of new skills to get around, and encouragement to get to wherever they want? This would be the rehabilitation model.

Does the goal for everyone have to be to walk again, and to lie about their progress when they cannot walk at all? Recovery in this context would be impossible, offensive, and cruel as unattainable.

This recovery movement, promoted at the highest levels of the federal government, as well as by bullying, inter-meddling state ideologues requires one thing. Staffing. It is in bad faith, to grow government and to plunder the tax payer without evidence of any benefit to the patient, or the family, or the neighborhood.

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."

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.

What I Got From my Internet Law School Education

There are 1.3 million lawyers in the USA. No more is needed, since this number exceeds the number needed by 500,000. When there are excessive lawyers, crime goes up, as the lawyer protects the criminal from citizen self help, the best remedy to crime. The tort lawyer deters not just defendants but entire segments of the economy. Without the lawyer, our growth would be 10% a year. There would be no economic crisis. The lawyer forced banks to lend to irresponsible minority members without ability to pay, just to consume and destroy property values. The family would still be thriving, and not on its last ropes.

So established professionals should forget becoming full time lawyers.

The modern law is based on supernatural core doctrines copied from the Catechism. In order to make modern students accept such supernatural concepts, indoctrination emthods are used in law school, rather than straight teaching methods. Lawyers are welcome to try to fit their law school experience to these methods of changing minds, and indoctrinatin fits best.


1) The basic "science of the law today is Scholasticism.  This is a philosophy mostly abandoned by even the Church. It sought to prove the existence of God by observation in nature.

2) One method of Scholasticism was the disputation to arrive at the answer to some important question. That was the likely origin of the adversarial system.

3) The core doctrines of the law were copied from the Catechism.To its credit the Medieval Church attributed these supernatural powers to God, in accordance with their faith. The lawyer believes that people are capable of these supernatural powers.

4) The lawyer  believes that minds can be read (intent for every element of a crime), that the future can be forecast (forseeability as the basis of duty).

5) No lawyer today understands the real meaning of the word, reasonable, the central and most important word in the law. One has to wonder why it is the central word, and not any alternative. This obliviousness would include Harvard Law grads with PhD in Medieval Legal History. The indoctrination has been that good.

Reason in Scholasticism is the ability to perceive God. It is the most reliable guide to making moral decision. Intellect is subject to being misled by the Seven Deadly Sins, resulting from the Fall from Eden. The most reliable guide to moral decisions is the New Testament, so St. Thomas Aquinas argued. The reasonable person must be fictional. If any juror bases a decision on a real person, no matter how high functioning, a mistrial will be called. The reasonable person must be fictional, in order to be "objective."What is not said is the the New Testament is the story of Jesus Christ. And the reasonable person is really a stand in for Jesus Christ.

So the adversarial system, the core doctrines, the extensive use of Latin, and the standards of conduct are all derived from the Medieval church methodology.  That makes them all violate the Establishment Clause, as much as any legal system based on Sharia might.

One could overlook this violation if the law were effective.

6) Every self-stated goal of every law law subject is in utter failure. Why? Because tgher eis noting from the 13th Century that is in any form acceptable as a practice in the modern world. This is explained by its extreme atavism, and use o Medieval doctrines.

Alternatives to "Life After a Lawsuit"

The AMA is a trip. This article describes helplessness and victimhood. It says nothing about another side of being sued for malpractice. That is the duty to protect clinical care from the vicious predators coming at it from all sides, including hate filled, scapegoating, entitled, greedy plaintiffs, who are real scum.

Some Perspectives

Doctors are Spoiled and Nearly Immune from Tort Liability

1) Say a practice makes $5 million a year. It gets all upset if it has four lawsuits of any kind. If it were a $5 million welding business, it would have 400 lawsuits all the time, permanently, as long as in business.  A large business, such a s Walmart, has 10,000 lawsuits at all times. This predatory practice is a huge heavy anchor on our economy, where a criminal cult enterprise, the lawyer profession, has total control of government, and uses it to enrich and empower itself by plundering all productive entities. This criminal cult knows doctors are crazy and violent once angered, so they stay away, mostly. (See Al Qaida, the Cuban Revolution, Ethnic Cleansing in Serbia,  for examples of doctors getting angry.) Doctors are a privileged group, almost immune.

2) When a lawsuit is filed, it fails at a rate of 80% at every stage of litigation. So, the smallest fraction of claims ever reach trial. Once at trial, jurors like doctors and give them the benefit of the doubt. Even in judicial hellholes, the verdicts favor doctors 75% of the time.

3) When spectacular losses make the newspaper, they are misleading. Baby makes $58 million, the headline may say. Baby really makes almost nothing is the reality. They baby will get the limit of insurance, such as $2 million. After the lawyer has taken out expenses and contingency fees, only a pittance is left for the baby. Greedy, low life parents are often shocked by this principle of no "Blood Money."

The Doctor has No Friend in Court Save the Jury

1) The defense lawyer is a traitor working only for himself. He will always want to get to trial because that is the only way to make a profit on a medical malpractice defense. He will allow his client to go through the wringer in a frivolous case to generate the profits from the rial. He does not need the client. He will never do anything that might scare, deter, or even inconvenience the plaintiff bar. He will never go after a biased judge. These are all duties to the client.

2) The doctor must hire, at his own expense,  a legal malpractice specialist to terrorize the insurance provided defense lawyer, looking out only for himself, and always orchestrating the case so a trial happens to enrich himself. There should be no pity shown this traitor. The malpractice lawyer must force the defense lawyer to file for motions to dismiss, for motions to disqualify  the lawyers, the judges, and the experts. Try to destroy the case as early as possible.

3) The process of discovery must brutalize all the enemies of clinical care, including the pro-lawyer biased judge, a hack, only slightly more morally upright than the felons passing thorugh his court. The judge is scum, and must not be spared any pain possible. Judges must come to pee their pants whenever a doctor enters the court, rather than the other way around. The judges are base cult criminals, sworn enemies to clinical care, scum who allow frivolous cases to proceed and refuse to punish irresponsible plaintiff lawyers. Demand all out e-discovery on the plaintiff, his entire family, the plaintiff lawyer for an improper motive, on all the named experts, and on the judge for his anti-doctor bias or pro-litigation bias. A full search for content in social networks should be done for all the adversaries.

This is  a proper motive for the tort claim: to make the plaintiff whole with money damages. Period. Every other utterance should result in a motion to dismiss, or to disqualify. For example, "It is not for the money." An improper motive. To prevent this from happening to others. To find out what happened. To send a message to the health care system. Any utterance indicating frustration or hate for the doctor. All improper motives. Use all appearances in the media as evidence of improper motive, since these are to get attention and notoriety, to embarrass the defendant into offering a settlement. All depositions should be relentless in their search for these case ending statements.

No Courtesies Nor Civility During the Trial

1) The malpractice lawyer must second guess every move or failure to make a move by the defense lawyer.

2) Ask the judge to question the jury in mid trial, whether any has used any electronic means to independently research any aspect of the parties or of the case. This is irresistible. It will be true at nearly every trial. Demand a mistrial and legal costs.

3) Use every utterance of every adversary, including those of the judge as a basis for many ethics complaints, using a specific Rule of Conduct from the applicable law covering professional ethics. This may generate dozens of complaints against the plaintiff lawyer, the experts, the judge. Generate dozens of investigations against each, so they all live in uncertainty, and not just the defendant, as in this article cited above. These investigations may have to be carried out for months after the end of the case. They have driven the targets from the field.

4) File cross claims against all other defendants. If one decides to settle, he will need your consent. You would not let anyone out unless they paid you or your wanted to. People will settle, and leave to suffer a trial alone. Do not allow that without thinking hard about it.

5) A doctor in the article sued the plaintiff and the lawyer for misuse of a civil procedure. This measure after the trial is a waste of time. The legal system is rigged airtight to encourage litigation and lawyer employment. One must possess proof in the form of a writing or recording of the lawyer confessing that the case was filed with knowledge of its lack of merit or confessing an improper motive. Impossible.

Alternative to the Misuse of a Civil Procedure after the Trial

The sole remedy to the frivolous claim must be found in the trial. The trial judge has limitless powers to punish the attorneys with costs, jail time, and seizure of personal assets, even dismissal of the case for misconduct (generating a legal malpractice case by the client). Make the defense lawyer traitor demand sanctions against the expert for any misstatement of facts (opinion is immune), against the plaintiff lawyer for misconduct (the doctor defendant should study the Rules of Civil Procedure to make informed demands of the defense lawyer.

6) The tort defendant has  procedural due process rights, the Supreme Court affirmed in reversing excessive punitive damages against an insurance company. One such right under is a right to a fair hearing. The defendant should take this list of biases, use it as a checklist, and see if any apply to the case, and demand a motion to dismiss if found (as early in the case as possible). Here is the list of biases.  The most important in medical malpractice are hindsight bias and outcome bias. The defendant may even blame himself and harbor an outcome bias against himself. This bias can be demonstrated to exist in defense experts. These are no more acceptable than other biases such as those against minorities.An argument using cognitive bias has never been made, let alone tested in a medical malpractice case, so the defense lawyer will resist it as having no precedent.

Deter the enemies of clinical care. Personal destruction has good moral validity. It is indeed a duty of the doctor defendant, to protect clinical care from its relentless enemies.

Nursing Home Litigation Not Related to Quality

According to the article, litigation increased in the 1990's. That happened to coincide with the greater funding of nursing care. The best correlate of litigation is assets not quality. The tort system is a really a system of lawyer plunder.


"High-quality nursing homes get sued almost as often as low-quality nursing homes, a new study shows. Researchers say the finding illustrates that litigation, or the threat of litigation, doesn't lead to improvements in patient care. Nor does it appear that better nursing homes are rewarded for superior care in terms of fewer lawsuits."

Read More .

NYT Article Bashes Modern Emphasis on Psychopharmacilogy

 Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy

Richard Perry/The New York Times

“I had to train myself not to get too interested in their problems, and not to get sidetracked trying to be a semi-therapist.” DR. DONALD LEVIN, a psychiatrist whose practice no longer includes talk therapy.

By GARDINER HARRIS

DOYLESTOWN, Pa. — Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.


Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry.
Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday.
Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

Dr. Levin has found the transition difficult. He now resists helping patients to manage their lives better. “I had to train myself not to get too interested in their problems,” he said, “and not to get sidetracked trying to be a semi-therapist.”

Brief consultations have become common in psychiatry, said Dr. Steven S. Sharfstein, a former president of the American Psychiatric Association and the president and chief executive of Sheppard Pratt Health System, Maryland’s largest behavioral health system.

“It’s a practice that’s very reminiscent of primary care,” Dr. Sharfstein said. “They check up on people; they pull out the prescription pad; they order tests.”



*******

It is impossible to do psychopharmacology without cognitive advice and content. The latter is a form of rehab, similar to physical rehab and exercise after an orthopedic operation. It is indispensable to the successful orthopedic operation. No surgeon would denigrate, short change a patient on it without hurting his outcomes.

For example. One has to say this or fail in treatment.

Your Abilify will reduce your impulsivity and will solely give you 5 seconds to think before acting. It does not give you the correct answer about what to do, nor coping skills, nor skills in getting what you want and need.

A year later, patients say, I have been doing it for months. Abilify taught me to think first. I can do it on my own. They stop the Abilify with their doctor, and many are right. They no longer need it, duplicating its effect with irreversibly learned skills.

Those skills are the rehab, the exercise of the operated limb. Does an orthopedic surgeon berate herself for not doing rehab, but for merely prescribing it for others to do? No. Nor should we berate ourselves for not doing extensive psychotherapy. The surgeon may briefly describe the exercise needed for success of the operation to the patients, and so may we. But sitting there practicing repetitive rehab is not the best use of time.

As to conflict of interest evidenced by withholding the possibility of response to psychotherapy.

All professions have a conflict of interest in making more money, the more people have problems, and less the more problems are solved. Professionalsim, pride in craftsmanship, and need to enhance reputation are all motivations for accuracy of advice, rather than trying to rip off the patient.

But try to give a bereaved person anti-depressant instead of counseling, they get a bunch of side effects, do not return, and bad mouth the psychiatrist to the referring family doctor or pastor. No psychiatrist will want that.

Eat a Sandwich from a Drug Rep, Get Reported to the IRS

I understand that drug companies will begin to send 1099's to doctors and others accepting meals. I wanted to get an opinion letter from the IRS about this practice. I believed those were gifts, not income. For example, I come to your home. I bring your wife flowers. Do I have to 1099 your wife at the end of the year? I thought the flowers were a gift. She did not work for me.

My accountant straightens me out:

"The following significant increases in user fees will apply: 

... The fee for a private letter rulings will increase from $7,500 to $10,000, except as provided for certain reduced fees explained below. A private letter ruling is a written statement issued by the IRS Associate Office to a taxpayer in response to its written inquiry about the tax effects of its acts or transactions or its status for tax purposes before the required filing of returns or reports.

Under the new fee schedule, taxpayers with gross income of less than $250,000 can request a private letter ruling for a reduced fee of $625 while a fee of $2,500 will apply to requests from taxpayers earning from $250,000 to $1 million. Currently, a $625 fee applies for a request that involves (1) a personal tax issue from a person with gross income of less than $250,000 or (2) a business-related tax issue (for example, home-office expenses, residential rental property issues) from a person with gross income of less than $1 million. 

... User fees for information letter requests are imposed for the first time, at $2,000. Information letters provide a general discussion of the law on a subject, not directed to any particular set of facts. Such letters can be issued when the taxpayer has asked for a letter ruling, but for some reason the Chief Counsel could not issue it. The taxpayer cannot rely on information letters.

In answer to your question, if you are deducting the flowers for my wife, a bottle of wine, or a box of chocolates, it is considered a business gift. Such gift are limited to $25/year to any single recipient [Code Sec. 274(b)].

If you buy a patient or colleague a meal, as long as there is a bona fide business discussion before, during or after the meal, you can deduct ½ of the cost. If you want to deduct 100%, the patient or colleague needs to pick it up as income. It appears that is what is happening here. The pharmaceutical companies are probably deducting 100% of the costs and making the Doc’s pick up the meal fair market value."

Many Medical Malpractice Claims Motivated by Anger. This is an Improper Motive

What the doctor is trying to say is the evidence points to personal animus as motivating most malpractice claims. Such a motive is an improper motive and represent lawyer malpractice if it is the real reason for the lawsuit, and the alleged deviation from standards of care and its alleged harm is just a legal pretext. The filing of such a retaliatory claim is an improper use of a civil procedure and itself a tort. The subject of anger should be deeply explored in any patient and family deposition. Then the doctor should file a countersuit against the lawyer, the plaintiff and any family member who encouraged the claim. An attempt should be made to get an injunction from a higher court against any judge allowing such venomous claims to proceed beyond first pleading to dismiss.

The overwhelming majority, perhaps up to 80%, of medmal claims are weak claims. They fail at every stage of litigation. The innocent doctor should not settle, and should consider countersuing the lawyer predator. To deter.

Because there is a first duty to survive and to stay open, the cover up is the most common response of any health entity to medical error. All investigational material will be subject to discovery and may ruin the health entity. One may conclude that these weak, hate filled, retaliatory lawsuits result in the shut down of investigations into systemic improvements that would eliminate medical errors. Every preventable medical error may therefore be caused by the medical malpractice lawyer, with no exceptions.

The Safeway Massacre. Thank the Supreme Court Again for the Murderous Rampage of a Paranoid Schizophrenic

Now this mass murderer qualifies for involuntary admission to a psychiatric hospital. Of course, first, there has to be a hearing employing 3 lawyers, one to prosecute, one to defend his freedom to the death, of others, naturally, and one to sit in the middle to make the decision. This judge, the lawyer in the middle, is totally unqualified to make any such clinical decision. Yet, this know nothing lawyer will loose the most vicious mentally people on the public, in pure evil.Paranoid schizophrenics murder around 2000 people a year, often with little or no provocation. Every single one of those murders is the responsibility of the rent seeking, lawyer sinecure creating, irresponsible Supreme Court.

Organized medicine has also failed to do enough to enact legislation overturning the horrid Supreme Court decision that took over psychiatry in 1976 to generate lawyer jobs. That decision had no justification since there was no abuse by clinicians signing two commitment certificates. And, if there were abuse, the doctors would suffer an endless series of investigations and punishments.

In the case of the paranoid schizophrenic who killed dozens of people at Virginia Tech University, there had been dozens of complaints about his psychotic statements, and threatening behavior for over two years. Yet, the lawyer protected pure evil from even reporting him to his family so they might get him back into treatment.

On the positive side, the public helped itself by taking a shot at him, and by tackling him. One worries that those heros will be prosecuted by the lawyer.

There Is No Child Psychiatrist Shortage, Just Laziness

Pediatrics and Family Practice sees 4600 and 4200 visits a year. Child and Adult psychiatriy see 2100 ambulatory encounters in 2009, each. This implies there is no shortage of psychiatrist or of child psychiatrists. It implies they are half as productive, and lazy. We do not need more psychiatrists or child psychiatrists, we need more that are willing to work harder. Earnings have not increased much. That means our productivity has stagnated as well. If the productivity of psychiatrists could approach that of Pediatrics or Family Medicine, it would be equivalent to doubling the supply of psychiatrists. The latter would also have the justification for demands of higher salaries and wages.