On June 3, 2010, my sister Anne Bremner, an attorney from Seattle, WA, who is a frequent commenter on legal matters on FOX, CNN, and other channels, was side swiped by a car, driven off the road, crashed, and hit her head and suffered a concussion. She was coming from a party where she’d had a couple of glasses of wine, but was observed to be functioning normally when she left the party.

She later admitted that she was bipolar and was on medications for the same, and that low levels of her medications caused her to have a manic reaction after the crash. She has pled guilty to Driving Under the Influence (DUI), and has stated that one drink before driving is one too many. During the manic episode she said some crazy things and acted in an erractic way, for which she is sorry.

She initially did not want to reveal her bipolar disorder as she thought it would affect her career.

OK, now, whoever thinks that revealing the fact that you are bipolar won’t affect your law practice, stand up and wave your arms.

[no takers? Oh, OK]

The fact is that Anne has never lost a case, as prosecutor or defender, from what I understand. Which means that she is a pretty good attorney.

The other thing Anne doesn’t talk about is our troubled chilhood, how our mother died suddenly when she was 7 and I was 4. How many people who had that happen to them do you know who are leading attorneys? I have been in therapy for several years related to this and I haved urged my sister to do the same, and take this “moment” as a wakeup call, as I took my own “wakeup call” of a few years ago.

Now let’s go back to seattletimes.com or seattlepi.com and see how many commenters heaped scorn on her late admission that she suffered from bipolar disorder to explain what happened. Most of them said it was an excuse, which shows that they don’t know anything about bipolar, or mental illness. The Seattle community can be quite provincial. In know, I grew up in the area. They call themselves “God’s Country” and think that anyone from outside the area is a mutant. The only challenge I ever got to this blog was when I wrote a (joke) letter to the landlord of Seattle journalist Philip Dawdy, stating that he needed to smoke because he had bipolar disorder (they were threatening to kick him out because he, gasp, smoked in his private residence). That triggered an official complaint to my university. Score one for the eco-fascists. As for the multiple people on truejustice.org or Perugia Murder File who have spent countless hours comparing my sister’s picture on her web site to random pictures on the web, and commenting on botox, hair pieces and other issues, don’t you see this for the sexism that it is? Trying to label a successful woman as “blonde” or focused on appearance is shameful when she is a successful attorney. Also spinning conspiracy theories about how she got help from local lawyers or psychiatrists is complete nonsense. If you need a support or social network, maybe you should look elsewhere than your True Crime blogs or local Seattle newspaper forums.

Maybe we should just take all people with the tag “mental illness” out behind the barn and shoot them. Which I guess includes my sister, who from whatever I can tell, is by any measureable standard one of the best attorneys in her city of Seattle.

View the video of today’s In Session here. Let me know if you have trouble accessing it.

Rebecca Riley is a 4-year-old from the Commonwealth of Massachusetts who was found dead at the foot of her parents bed, covered by only a blanket, in 2007. Rebecca had been “diagnosed” with ADHD and bipolar disorder since the age of 2 and treated with Seroquel (quetiapine), Depakote (valproic acid), and clonidine, none of which are FDA approved for use in children. Autopsy showed more than ten times the therapeutic level of clonidine (whatever that is) in her blood stream, and forensic experts ruled her death due to heart and lung damage caused by prescription medications.

Clonidine is an alpha-2 adrenergic agonist, meaning it acts on the noradrenergic system to shut it down. Seroquel is a powerful antipsychotic, and Depakote is an anti-epilepsy drug that has been used for a variety of mental disorders. Those in combination with cold medications to treat her drug-related pneumonia probably did her in. Although doctors can “legally” use medications for non-FDA approved uses, that doesn’t condone poor medical practice.

This tragic case turned out to be related to the willingness of her parents to use psychotropics to drug all three of their children. Rebecca had to be helped to walk up the stairs and sit in her chair at her pre-school, and was frequently noted to be drugged. The parents were getting SSI for the two older children and were working on getting it for little Rebecca as well. Their disabilities seem to be related to being over medicated. And it was clear the patients were using the medications to keep their kids sedated and easy to manage.

The FDA has perversly approved Abilify and Risperdal for use of bipolar disorder in children, even though bipolar disorder in children has never been recognized as an official disorder in DSM. Diagnosing two year olds with disorders of concentration and behavior is perverse, to say the least. The unfortunate trend in psychiatry to expand psychotropic drug use doesn’t seem to be coming to an end. I will be on the show “In Session” on TruTV talking about this case and the trial of Rebecca’s father, Michael Riley, tomorrow at 9 am EST. Her mother Carolyn Riley has already been sentenced to life in prison for the murder of her daughter.

Yesterday we converged at Emory University to present a letter to President Jim Wagner requesting that Emory join with other dialysis centers in Atlanta, GA to help provide care for the 33 dialysis patients whose extension of life-saving dialysis ends next week. We then traveled to the Fresenius Dialysis Center at 231 14th St in Atlanta, where treatment of the patients is ending Aug 31 2010, to present a similar letter. Today there was a protest at Grady Hospital. Time is running out for these patients and it is really disheartening that money is thrown after expensive medical procedures in this country that do not clearly work, while something like dialysis that means the difference between life and death is denied to some people.

Read prior posts on the history of this issue here.

 

I invite doctors and other healthcare workers to speak out about the death sentences being handed out to patients.

Sign the petition to save the Grady dialysis patients here.

After August 31, 2010, thirty three (33) uninsured End-Stage-Renal Disease patients of Grady Memorial Hospital will no longer receive their life-sustaining dialysis treatments.

- In September 2009, Grady Memorial Hospital closed its outpatient dialysis clinic. At that time the thirty three (33) uninsured patients, most of whom are immigrants, were promised dialysis for one year from Fresenius dialysis facilities as specified in the Grady Memorial Hospital – Fresenius contract.

- On August 31, 2010 the Grady Memorial Hospital – Fresenius contract expires.

- To date, no alternative source of dialysis treatment has been made available to the remaining thirty-three patients.

- The patients will die within weeks of the August 31st deadline if they are not provided with ongoing dialysis treatment.

As advocates for human life, please sign the petition below to encourage the private dialysis providers of Atlanta, Georgia, to supply the 33 indigent patients of Grady Memorial Hospital with life saving dialysis care.

Here are some facebook groups you can join to keep abreast of the issue.

Protest the Grady Dialysis Cuts

Protest Grady Hospital’s Sentence of Death for Dialysis Patients.

Advocates for Responsible Care – Group

Read all posts about the Grady dialysis situation here.

and imminent sentence of death for 33 patients on Aug 31 2010. Interview by Grady physician Neil Shulman MD

Part 1

Part 2

Part 3

I signed up for the comcast bundle and was given an install date. The sign up was this online chat thing that took two hours as the rep was obviously “chatting” with ten people at once. I took the day off and stayed at home and waited. Noone showed. I called comcast and the automated line said the install was a week later. I thought maybe I made a mistake. Next week, again no show. I called and the date is now a week later. I stayed on the line and talked to a rep. They said that it took 5-7 days to “port” my old phone number from At&t to comcast. But it was now almost a month later. I asked why noone had bothered to notify me about the change in appointment. They said that an “automated call” was sent out, but I received no call. And the fact that this happened twice indicates to me that in fact no call was generated. They said they would try and get someone to come out that day. At the end of the day they called and said someone would come the next day. I again stayed home the next day. I called the automated service and the message said that the appointment was a week away. I got a rep on the line who assured me that they were coming between 11-2 that day. At 2, noone had showed up. I called back and they said my appointment was for a week later. I explained that I had been assured they were coming that day. They said someone would call back within the hour. No call. I called to cancel my subscription and was asked why? I explained the situation and they said they would get someone out there that day. I also asked if they would connect my Tivo or if they had DVR. and they said I would have to hook that up myself and they didn’t know if the techs had a “Tivo card”. Noone showed up anyway. At the end of the day someone called back and said they would cancel my subscription. Then I got another call asking why I was canceling? So frustrating. I went online and got an appointment for At&T U-verse with an email confirmation with no problems.

Pete Correll, who heads up the Board of Directors of the Grady Memorial Hospital, which provides care for the indigent in Atlanta, GA, was behind the heartless decision to pull the plug on patients receiving dialysis, which is a life saving treatment. When confronted with this at a medical board meeting, when all of the patients were present, he took out a full page ad in the Atlanta Journal Constitution defending himself. Do we detect a note of bad consciouss? You see, he had been tasked with helping Grady “make money”. But Grady is a hospital for the poor. It used to be that doctors saw their role as helping people. But now the hospital and insurance administrators are teaching them to think about making money, and not thinking about the welfare of their patients.

You can see Correll whining about being called a murderer. But what else is he if he pulls the plug on a treatment required for survival. And his comments about making money for a hospital that was established to provide treatment for the poor and indigent are ridiculous.

Let’s get doctors in charge of these boards and organizations. Not heartless former CEOs of organizations.

 

read for yourself and decide based on this ad taken out in AJC after the board meeting.

Neil Shulman MD gave a talk at a recent Emory Cardiology Research Conference about the plight of the Grady Hospital dialysis patients. (Read all of the posts about Grady dialysis here). A year ago, we the Grady patients received a death sentence after the board of directors decided to close the dialysis clinic and told the patients to go back to their countries or bugger off in general. In conjunction with the Advocates for Responsible Care we filed the patients into the board rooms and subsequent court hearings filed by Lindsay Jones on behalf of the patients. With some effort we got them to provide a year of treatment through the private clinic Fresenius, but now their time is up on August 31. At the conference one of the doctors said that the power of doctors is eroding, and increasingly it is the situation where administrators tell the doctors what to do with their patients. Funny, I didn’t think they should have the power to do that, but what the hey…

Meanwhile, at least one woman went back to Mexico, where she died because she couldn’t get dialysis, another went to Florida and almost died, then came back to Georgia, and there are several other stories like that. There still are 33 patients who need dialysis who are still alive who will be affected.

Meanwhile, the CEO of Grady, Michael Young, got a $300,000 bonus for saving money at Grady, which is the priority these days.

Pete Correll is former CEO of Georgia Pacific who runs the board of Grady. 

Baxter sells supplies for dialysis and charges twice as much for the dialysis supplies here as it does in Mexico. Maybe we should smuggle some over the border. We are asking Fresenius, DaVita, and Emory to provide compassionate care for these patients.  Robert J Parkinson, Jr, is president and CEO of Baxter.

 Kent J Thiry is CEO of DaVita, a dialysis company which has recently come under scrutiny for milking the use of the drug Epogen in dialysis patients for treatment of anemia.

Thomas Lawley MD is the Dean of the Emory Schoo of Medicine and is on the Grady Board. I have gone to the meetings but he usually just sits there and doesn’t say anything. Emory supposedly has picked up a few patients but they could do more to get these other harbingers of corporate greed to do something.

 

Ben J. Lipps, PhD, is the CEO of Fresenius who is the largest provider of dialysis in the US. They pay Lipps $4,310,000 a year in salary and compensation each year. (Maybe he could donate some to dialysis patients) Although Fresenius is a German company, they have adopted well to the American system of putting profits over people when it comes to healthcare. If a situation like the Atlanta dialysis situation occured in their home country, the local population wouldn’t stand for it.

The problem is that medical decision making is slowly being taken away from the doctors and put into the hands of people who don’t have the experience of connecting with people about their healthcare. Witness how administrators at Grady asked the doctors there to sign a statement saying that it would be fine for dialysis patients to get their dialysis only through the ER and on an as needed basis. They refused.

If each of these entitities would take on a few charity cases, like they used to in the old days, the problem would be solved.

Note: the post was updated one day after the initial posting.

See this article by UW-Seattle nephrologist Rudolph Rodriguez MD arguing that physicians have an ethical imperative to help these patients.

Dan Carlat MD has just come out with a book on American psychiatry that has got a lot of people talking. In Unhinged: The Trouble With Psychiatry – A Doctor’s Revelations About a Profession in Crisis Dr. Carlat describes the practices of the typical psychiatrist. In order to generate the most income, most of the appointments are 15 minute “med checks,” and the treatments are based on psychopharmacology and the biological psychiatry model. Patients are fed the pharma marketing explanations of how psychotropic medications work, providing solace for all involved, although there really isn’t good evidence for the explanations. Meanwhile, psychiatrists have farmed out therapy to the other professions, and have adopted a herd em through mentality toward their patients.

A July 13, 2010 interview about the book with Dr. Carlat on NPR’s “Fresh Air” show (which you can listen to here) has evoked some controversy. Giovanna Pompele wrote a critique on the Beyond Meds blog that takes him to task for his comments. She feels that by describing these practices and not apologizing for them, or implying that they still go on, that he is committing an offense. He also had some people throw some rocks about the implication that psychiatric training did not place a high value on therapy training.

I’m not sure I really see it that way. I think it is good that he is bringing this stuff out into a public discussion. I too used to give “drug talks” (see “Confessions of a Psychnetter“) but at the time I deluded myself into thinking that I was providing a useful “education”. However when they wouldn’t let me pick my own slides I realized I was doing nothing more than paid ads for the drug companies, and they dropped me for being difficult. I didn’t like it anyway, because the conversations with the psychiatrist attendees were like “I gave her Zoloft, and she got sleepy, so I gave amphetamines, and she developed… what should I do now?” Years later, the situation has degenerated to the point where my academic physican colleagues openly bemoan the fact that they can’t give “promotional talks” (yes, they actively call them that now). As for clinical work, I refuse to do the 15 minute med check thing, and restrict my clinical work to doing one hour evaluations. The part about telling patients that antidepressants increase serotonin in the brain is kind of a joke, because that is just marketing PR, and researchers like myself who have spent a lot of time reading the primary literature know it is a joke. However I’n not sure how much psychiatrists in the community have read that literature.

The idea of prescription medications like psychotropics being used to treat chemical imbalances has been burned into the public consciousness. Just take the example of Lindsay Lohan, who is on trazodone, Zoloft, Adderall and dilaudid, mixed with alcohol and cocaine, just one in a string of celebrity disasters to bite the dust on these lethal combinations. And when I pointed that out on TV last night, a caller practically took my head off, and there was a general discussion about her “depression” and how she needs to keep her meds in jail. How do we know she has real depression until all those drugs get out of her system? You don’t throw prescription meds at people who are actively abusing drugs (oopes, unless they are a Hollywood celebrity, of course).

I also see a little bit of the reaction to the acadmic psychiatist speaking the truth syndrome which is like “get him!” The whole psychiatry field has been perpetuated by myths and disttortions for so long that when someone talks frankly everyone freaks out.

By way of disclosure Danny wrote thispost in my support last year. I mention this as as a disclosure of my potential bias.