Cuckoo's Nest Revisited: Diagnostic and Treatment Incompetence at a University Based General Hospital in the Case of Antidepressant associated Mania
This is Your Brain. This is your Brain on Drugs. Just Say No.
Statement of Purpose
Thank you very much for investigating this case. Your acknowledgement letter states that patients should forward all their evidence. The brochure states discussion with the medical consultant is not possible, and the records used in the investigation are sealed to everyone else. In that case, this patient wishes to offer further argument to support her case, before the final decision is reached, and will submit a concluding argument. The key element is that this report is true. If some specific point needs further evidence, a credible source can be found. This patient has no proverbial skeletons in her closet. Medicare has a record of all her providers, and the Medical Board may check them.
If this was a medical malpractice case, treatment that made a patient much worse would be sufficient for a lawsuit. Through involuntary confinement, the doctors changed the rules of the game. The reports of a mental patient have no credence without third party affirmation, and no lawyer will even consider the case. The genuine welfare of this patient was never a consideration at any time. Dr. Lee and Dr. Nygren both note this patient threatened a lawsuit, and their intention was to force her to take drugs to alter her perception. Competent doctors have nothing to fear from lawsuits. All the doctors in this case knew they were liable.
BAD is very easy to treat with medication. Post Traumatic Distress Disorder involving nightmares, and recurring thoughts is a rare expensive specialty. Both these doctors made involuntary treatment decisions that permanently harmed this patient. The Medical Board must protect the welfare of involuntary patients by providing them, the official affirmation to pursue a lawsuit. The doctors malpractice insurance should pay for this patients PTSD.
Go Ask Alice, When Shes Ten Feet Tall
Doctors hate to admit, they addict, as effectively as drug dealers do. This patient was never in treatment for mania from 1989-1997, or from 1999-2003, because medication never induced it. In nine years, she never entered SFGH, until she was taking five new prescription medications. When Dr. Nygren added the 6,th it was too much. Most doctors cannot discern spontaneous mania from substance induced. They err on the side of BAD, because it absolves them from liability for their medication decisions. This case is exactly what happened in 1989. This patient was prescribed Xanax with other anti-depressants, and it induced a manic episode. After it happened, Dr. Bermon said it was BAD. In deference, there was far less clinical evidence for anti-depressant mania. By 1998, there was abundant evidence for problems with Paxil and Xanax.
BAD is a degenerative brain disease, with a literal subculture of symptoms and behavior patterns, not limited to mania. Substance Induced Mood Disorder is temporary, directly related to intoxication or withdrawal in the window of a month. It is a debilitating, adverse reaction to medication, and recognized by the patient as such. Spontaneous mania provides some gratification to bipolar patients, so they resist medication to treat it. The entire body of records depicts this patient, as a drug addict in withdrawal.
Instead of enjoying her mania with fornication and spending sprees, she was an irate consumer demanding relief from withdrawal. She dropped by, to demand medication, and voluntarily entered Psychiatric Emergency Services three times to make her symptoms subside. This is not the behavior of a manic bipolar patient, concerned with the loss of mania. The patient understood she was in withdrawal, why would the doctors not? As the attending psychiatrists, Dr. Nygren and Dr. Lee were both negligent for not reviewing this patients medication pattern, before they forced her to take Depakote.
The key to discerning withdrawal mania from spontaneous mania is the emphatic severity of the physiological symptoms, without psychotic features. Throughout the records, the staff assessed her as psychotic, because they never validated her authentic psychiatric and social history. This patients most incapacitating symptoms were motor agitation and pressured speech, and she insisted upon medication to stop it. In withdrawal, she presented as a drug addict on speed, an alcoholic with delirium tremors, or a junkie. Withdrawal from Paxil is like heroin withdrawal. It feels like experiencing a seizure. Pressured speech and motor agitation are intolerable. Rather than feeling a decreased need for sleep, it is experienced as, exhaustion with insomnia. The term manic-like is used with anti-depressant mania. If the doctors had treated this patient for withdrawal, this debacle would have been avoided. After forced to take a mood stabilizer, this patients condition rapidly declined. After confinement with involuntary Depakote, this patient was much worse, and will never afford recovery.
This patient reported drug induced manic episodes from Demoral and Xanax, and was immediately prescribed Paxil, Ativan, Dalmane, and hormones. With five new medications, how can anybody discern the effective one? The doctors prescribe polytherapy, and record the drug the patient reports as helpful. Dr. Nygren reports Pt. reports Paxil helpful. Who knows? Maybe the Dalmane, Ativan, and hormones were helpful. In prison, Dr. Lansky reports, in her own bad grammar, Pt still emphatically feels Paxil is the best medication for her, but willing to go along with plan to d/c Paxil because she also notices she is now cycling up more. The deceit is that the patient had a choice. This patient was taking nine other drugs, how could anybody determine which drug was effective? This patient was, overmedicated, out of her mind. A Nobel Prize doctor could not determine, with certainty, how ten drugs combine in any individual. The safety and efficacy of this combination has never been tested in clinical trials. This patient has a dangerous, unreliable response to medication, and nobody will ever understand why. The point of this case is that she reported it.
The FDA warning states Paxil should be used with caution in patients with a history of mania, and has withdrawal syndrome. The discharge reports state it made the patient, more manic. Nevertheless, doctors prescribed it, before, during, and after hospitalization. Who is responsible for prescription drug mania? The patient? She understood that small doses of the same medications, without gaps, are a stable regimen. The doctors prescribed 30 of this, 28 of that, 14 of this, and 10 of that, intermittently. How does that affect a bipolar patient, or anybody else? The precise medication pattern leading to confinement can be sequenced in further detail.
April 21, 1998 This patient was prescribed 60 mg of Paxil. The cult song lyric, One Pill Makes You Larger, and One Pill Makes You Small, is not a reference to street drugs. Doctors prescribed the proverbial, Nineteenth Nervous Breakdown. This dosage was too high for anybody, who had a manic episode from Xanax.
May 21,1998 The pharmacy receipt documents a dispensing error. On May 22, Dr. Lovett prescribes 2 weeks of Paxil, Ativan, and Dalmane, 28 pills, with a new appointment June 23. With 31 days in May, the patient is scheduled for discontinuation syndrome. Her hormone medication drops to a 14-day supply. Does this gap in medication affect the patient, and who is responsible?
June 28,1998 This patient went to the emergency room, because she knew she was in withdrawal, and could not function. Ativan alleviates her symptoms, temporarily. The patient reported she was out of medication for weeks, because she tried to explain the original pharmacy error. She was advised to contact her regular provider. There was no opening available.
July 9,1998 Dr Nygren might have alleviated this patients misery, with a two week supply of the same medications, at tapered dosages. She notes pressured speech, agitation, and the patients next appointment with a novice intern. She only prescribes 30 Ativan, 10 Dalmanes, and no hormones. As the psychiatrist in charge, she should have seized control of the case. An attending psychiatrist sending, an alleged bipolar patient, to an intern for Paxil medication is unbelievable. She should have reviewed the patients entire medication history, and evaluated its effectiveness.
Addendum. Insisted on Dalmane in escalatory manner. Wrote her ten to appease her. This is the definition of prescription incompetence. All that was required in this situation was temporary medication continuity. A patients symptoms must be evaluated in relation to the previous medication pattern. Psychiatrists should be the most qualified, to assess the complex interaction of anti-depressants, and hormones. Does the average manic bipolar patient demand sleeping pills? That is addiction withdrawal. Do competent psychiatrists appease patient demands, or diagnose and treat?
July 10,1998 Dr. Sexton reports affect more stable and appropriate. This is concrete evidence that Dalmane alleviated pressured speech, and agitation. On July 19, the patient would run out of Dalmane and crave Paxil. Who knows the effects of irregular hormone therapy? Now they are considered dangerous.
July 22,1998 Dr. Hamauri notes mania and pressured speech, and prescribes Paxil, Ativan, Trazodone, and hormones. He states, Pt. describes an investigation of her case into mistreatment by all providers, attributes her decline to experience at SFGH. Irregular bleeding since she d/c hormones. This is one of the best lines in the record. from a male doctor, cannot explain her description of cyclic PMS sx. This patient knew then, her medication pattern was responsible for her symptoms. Only the doctors were confused.
July 23,1998 Dr. Nygren notes that the patient is calmer, without agitation or pressured speech. This is the second concrete evidence of the medications that treat agitation and pressured speech in this patient. If a patient has to think back to an earlier decade, for memories of lithium, she does not need it daily.
August 7,1998 Dr. Sexton. Pt. started Depakote 8/4, reports less agitation, ride effect of mania This patient still has no idea what ride is, and never said this. This drug resulted in the patients rapid deterioration, just as lithium did in 1987. The patient complains she is sick to Dr. Nygren who tells her to stop medication until the next session. The doctors already plan to confine this patient, when they both know it made her sick. In retrospect, it seems they already knew they were liable. They had to prove the patient was prescribed a mood stabilizer, to justify competent bipolar treatment.
August 11,1998 Dr. Nygren suddenly decides this patient is hypomanic to manic and suddenly needs the hospital to stabilize the patient on Depakote. The patient accused her of not renewing the same prescriptions on July 9, whose withdrawal brought her to the emergency room. She accused both doctors of forcing her to take Depakote, when she knew it would make her sick. No patient would consent to take a new drug that made her dysfunctional a few days earlier. Dr. Nygrens absolute negligence, was leading the PES staff to believe this patient had a prior history of stabilization on Depakote or lithium.
This is the normal medical assumption with a bipolar patient. Since this patient had medication-induced mania, a decade earlier, she never had a bipolar medication regimen. Depakote was not indicated in this case, which is why it never improved her condition. PES Dr. Mark Schiller forces this patient to begin Depakote at 500mg in a locked facility, and writes the total fabrication, patient was put on Depakote 2 weeks. In the 24 hour assessment, Dr. Lee invents this patient has not been taking medication for several weeks, and forces her to take 1500mg. They seem to have no comprehension, they were forcing this patient to try a new drug.
August 13,1998 This patients level is forced to 133. She is secluded and restrained for possibly 36 hours. This traumatized her for life. Rather than subjecting this patient to torture, abuse, and sexual violation, the doctors should have prescribed the highest dosage of Valium or Seconal known to man. Death by sedation would have been more humane. The doctors were sadistic.
Depakote Intoxication in Antidepressant Withdrawal
Depakote intoxication had a profound affect on this patients mood; it made her manic, and much worse. It is necessary to describe the physiological symptoms of rapid escalation to therapeutic level. Each dose increased the intensity.
Nausea Hospital food was nauseating, but chemical nausea is insidious.
Dehydration This discomfort was similar to antihistamines in cold remedies. The body feels parched, but the stomach cannot tolerate the liquid to quench thirst. The nurses note this patient demanded attention. This patient demanded waitress service, because she was not permitted to get her own beverages. She was forced to stand at the kitchen door, and stare at the refrigerator until somebody would get her a drink. Ice was rationed.
Eyes The most severe dehydration symptom was dry eyes, that made contact lenses painful, and the hospital did not stock artificial tear products. The staff considered vision impairment insignificant at all times. The drug blurred vision.
Tremor The term fails to encompass the gradual loss of motor control. The body feels like it is turning to jelly, and involuntary movement overwhelms it. Parkinson is most noted in the arms and hands, but feet, shoulders, knees, and the head are affected. The sense of movement is spastic.
Mouth The first affect is slurred speech, but the saliva glands pump in strange ways, so it is impossible to speak without spitting. The jaws move strangely, the teeth gnash and grind, so you keep biting your tongue.
Headache The ache was usually centered in the sinus area, but there was throbbing in the temples at times.
Aches and Pains There was an assortment of odd pains in the area of the ovaries, the base of the spine, and the shoulder blades. It was just horrible.
Perception The simplest analogy remains intoxication with hard liquor, the room seems to be swimming and focus is difficult. Dizzy. Response to the environment may be described as intoxicated.
Shockwaves There was a decided sense of something coursing through the system at intervals. It was the sensation of poison invading every cell individually. Overmedication feels like overmedication.
Depakote had a decisive effect on this patients mood; it made her miserable. Irritable and angry does not approach the response to this torture. She could not abide them in the tranquility of the Ramada Inn, and they were unbearable in prison. It was absurd to think anybody would consent to this rapid deterioration in functionality. This paved the way to restraints. The discomfort was intolerable, and this patient wanted an explanation, why the staff was forcing her to endure this. Rather than treat this patient at her obvious level of comprehension, the staff treated her for 23 days, as though she were mentally challenged.
This patients reality based insight, that medication induced her symptoms, never altered in any way. She was forced into anti-depressant withdrawal and Depakote intoxication, which never improved her condition. The hospital staff babbled about, this venom, improving her quality of life. The hospital records do not indicate this. This patient could never function in the external world on this medication, which is why she never took it, before or after, this period. Did the doctors think the patient would teach high school in this impaired state?
Just Say No
Both Dr. Nygren and Dr. Lee report this patient was unable to make safe decisions about shelter. This was never a problem, before the patient entered treatment. She was unable to make safe decisions about shelter, or anything else, because she was impaired by prescription medication. From the very first consultation with Dr. Sexton, he coerced her to take drugs. Treatment without medication was never an option. The doctors addicted her to dangerous psychotropic medications, and sent her to prison, when she refused to try a different one. SFGH medical records are a journal of this patient on drugs.
This patient has, usually, entered treatment with professionals in private practice. When she consulted with Dr. Sexton the first time, she was treated by Rachael Cunningham in private practice. He insisted she sever this effective therapeutic alliance, so he could assume, full treatment responsibility. SFGH just swept her into the social welfare system, and subjected her to some secret treatment policing system , without ever explaining the rules. The medical records read like Gestapo reports. There is a disparaging, imperious tone running through them all, that shows almost contempt, rather than concern for the patient. Patient must commit, confronted patient, informed patient, monitored patient patient refused. patient was put on. Since this group of geniuses made the patient worse, and destroyed her life, who was grandiose?
In private practice, a doctor would renew medications, over the phone, especially if he dispensed 28 pills in a 31-day month. That is not entitlement, it is standard protocol. Competent doctors diagnose, explain, and suggest.. Patients are entitled to a second opinion, informed consent to try new drugs, and always have the choice to leave treatment. What did these doctors think they were doing? Dr. Nygren and Dr. Sexton made Depakote their final treatment decision, and the patient had no legal way to evade this. Despite the patients initial negative response, they filed legal papers against her to take it. In retrospect, there can be no doubt, they made a premature, uninformed decision.
By designating this patient non-compliant, they essentially criminalized her, for not following their treatment plan. The prison staff records are full of reproach. They imply the patient had a bipolar medication regimen, failed to follow it, and caused her own manic episode. This was never the case; the doctors were forcing the patient to take a new medication. The efficacy, and adverse reactions of this medication, to this patient, was unknown. Saying no was never an option until August 27,1998. Forcing a patient to take medication is one thing, forcing her to sign a paper consenting is something else. The hospital staff wanted the authority to force compliance, without liability for the outcome. This was sinister exploitation. Welfare doctors make arbitrary treatment decisions, because they know the legal system will never hold them accountable. The homeless to them are like garbage that intrudes upon their day.
The patient, questioned the physicians medical choices, and said she was not going to take medication when she left the hospital. The patient had no option to withdraw from drugs. Mrs. Mercurio was offered nausea, tremor, tardive dyskinesia, insomnia, dry eyes, or slowed movement, confusion, blurred vision and exposed breasts. The most effective medications for this patients symptoms were Dalmane and Ativan. She was manic-like on July 9, and they calmed her on July 10. She was manic-like on July 22 and calm on July 23. These benign drugs were all she needed. The patient never disputed her symptoms, merely their cause and treatment. If the patient had participated in her treatment decisions, she would have been much better in a few days.
Dr. Sexton, Dr. Nygren, Dr. Lansky, and Dr. Lee held persistent false beliefs about the patients psychiatric history, and socioeconomic status. They lacked insight into known adverse reactions to their prescriptions, and the patients authentic medication history. They used poor judgment forcing her to take drugs, when her condition clearly declined. This patient entered therapy living in an apartment with an income of $975 a month, the right to earn $500 and no prescription medication. After six prescriptions, two therapists, and involuntary treatment, Dr. Lee wanted to lock her in a residential facility. The hospital blames this on the severity of this patients BAD, which is not supported by the evidence. This paper is this patients mind, SFGH records are her mind on drugs. If the patient never entered treatment at this facility, she would be fine today.
The doctors assumed full responsibility for her treatment decisions in 1998, and they should assume full liability for the disastrous consequences in 2003. This patient wants damages to pay for treatment for Post Traumatic Stress Disorder. Does any doctor who reads this paper, think that they can change this patients perception of these events with a mood stabilizer? New Jersey professionals admit they cannot. Is justice ever a consideration in medical affairs? If any other people in the world, confined, tortured, drugged, abused, and violated this patient, they would be criminals. This patient will never view them in any other way.
