Statement of Purpose

The purpose of this paper is to prove, beyond reasonable doubt, that Dr Emily Lee was derelict in her duties.  She involuntarily confined this patient to Ward 7A at San Francisco General Hospital from August 11-September 3,1998.  As the result of Dr. Lees involuntary treatment, this patient was permanently harmed, and remains disabled by nightmares from the abuse she suffered in this psychiatrists care.

 This is an evidence-based report, and the supporting documents are available by fax from the patient, or her Patient Advocate, Norma Block.  If any point requires clarification, or further evidence, this can be arranged.  This paper is presented as a formal Community Mental Health Grievance.  The goal of the grievance is to obtain a formal letter from this doctor acknowledging her errors, and addressing the major issues of contention.

Dr Emily Lee

On August 27, 1998, Dr. Lee committed perjury in Superior Court [i]by filing false information about this patient, so that Mr. Lau could assume full Conservatorship of this patients welfare.  The court document proves this psychiatrist held persistent false beliefs about the patient which she placed into the public record, and served as the basis for reality testing at all times.

Income: None

This patients Wells Fargo Bank account statement proves that she had a monthly income of $975 a month from SSA,[ii] and that the bank extended a credit advance of $200 per month.  At the time, SSA recipients were permitted to earn $500  in wages.  This is significantly more than none and too much income to qualify for Medical.

Assets: None

This patient had truly valuable antiques stored at Security Public Storage, and in fact paid her storage bill [iii]on the way to her civil commitment for grave disability.

The patients most valuable piece of equipment, her custom camera,[iv] was ultimately lost because it was safely stored in a vault in a pawnshop.  Since these establishments only accept cash or money orders, and the sum was due on August 25,1998 this patient ultimately lost her camera, because she was confined to Ward 7A and was not permitted to pay her bills.

Marital Status Single

On August 14, 1998, Dr. Lansky personally spoke to this patients husband.[v]

Relatives

Dr. Lee carefully lists this patients only relative as her brother who spends most of August on Long Beach Island, so it was doubtful that any phone contact was made.

The patient noted that her sister was the main blood relative contact, because she shared the Wells Fargo Bank account.

Perhaps the patients sister was not mentioned in court, because she accurately expressed the familys opinion about another psychiatrist.  Dr. Bermon: who was a witchdoctor who gave her a whole grocery bag full of medications, and should not be allowed to practice.[vi]

548 Ashbury St.

Dr. Lee told the court that the patient was living at 548 Ashbury Street, which was the address on this patients stolen California ID.  When the patient left the hospital, one of her first tasks was to replace the items stolen or broken in the hospital.  She applied for her new California ID[vii] on September 10, 1998 with the address of the Casa Loma hotel where the patient lived before and after her confinement.

©

Since the patient was a licensed teacher, and a licensed public librarian with a Masters Degree,[viii] the patient was held to academic standards for the duration of her career.  How many times are licensed psychiatrists permitted to lie before they are eligible for reprimand?

 In other chapters, this paper has proved beyond reasonable doubt that Dr. Sexton, Dr. Nygren, and the PES doctor lied in their records.  How many hospital doctors are permitted to lie in one California civil commitment case, before it becomes a breach of trust?  Dr. Lee was as negligent in her medical care of the patient as she was with her legal paperwork.  Dr. Sexton sent the patient to the hospital[ix], and assessed her to be much worse after hospitalization.[x]  How does a woman get much worse?  Step by step, day by day in a prison environment ,where the medical staff made bad treatment decisions against the patients will.

Dr. Lee notes the patient was unwilling to accept treatment voluntarily.

The patient had evidence-based insight into her own psychosocial, psychiatric, and medical history at all times.  Why would she accept treatment from a doctor endangering her welfare with neuroleptics, trying to convince her she was an indigent?  To fully explain this patients unwillingness to be treated by the hospital staff, it is useful to examine Dr. Lanskys report the day before Dr. Lees perjury.  This simple page constitutes a summary of the hospital's malpractice, if justice is ever a consideration in medical affairs.

Dr. Lansky August 26,1998.[xi]

It is difficult to establish ,a rank priority ,of abuses documented, but the novice intern demonstrates the ethics of her mentor.  She blatantly lies that the patient seems in general grateful for her treatment.¨  At the risk of repetition, this patient quotes her own response to psychiatric abuse when it began, and it reflects her opinion today.[xii]

1.     Pt appears disheveled and very upset.

2.     Attitude is angry, indignant, and humiliated.

3.     Mood is anxious and agitated.

4.     Thought content focused on hospital being cruel and unethical to her.

5.     Pt threatening a lawsuit and to call Geraldo Rivera.

This report was made @10:40 on August 13,1998 and then by 11:30 the doctors made the decision to forcefully treat this patient with Haldol.[xiii]  This was never done for the safety or welfare of the patient.  The doctors quickly attempted to coerce the patient to risk tardive dykinesia, and sign a consent form.[xiv]Consent forms are devices to protect doctors from liability, because drugs are dangerous.  If the patients cognitive skills were intact enough to attempt to refuse Haldol, then she was never a legitimate candidate for chemical restraint.  Dr. Lee notes that after only three hours of forced medication with, the most dangerous old-line neuroleptic, the patient was indeed banging on the door of the jail cell.[xv] Medication-Induced Movement Disorders from neuroleptics is a well-understood clinical presentation.[xvi] No amount of medication has ever changed her memory of those events.

Seclusion and Restraint and Sexual Violation

The California Senate Office of Research has published a report on the State of California website titled Seclusion and Restraints: A Failure, Not a Treatment.  The patient knew she was abused, but the paper might instruct psychiatrists with poor judgment and lack of insight into human trauma.  Forcing people to sleep in their own excrement is universally considered abuse.  The report presents a model that explains how civilized, educated, humanitarian professionals treat trauma patients.

 The most pertinent point in this case is the premise that once patients are abused in this manner, further trust between patient and staff is impossible.  From the very moment this patient was assaulted by the orderlies, she ceased to view the staff as anything, but a horde of barbaric prison guards, with full authority to violate and debase her at their discretion.  Further research into the topic, simply confirms this patients initial response.  The full chapter about abuse is devoted to the nursing support staff.  The psychiatrist in charge was negligent for not recognizing the symptoms of trauma, then, when it was still evident years later.[xvii] At any time, a competent psychiatrist could have treated the obvious symptoms.

 Dr. Lansky clearly documents at least one case of male nurses violating the patient,¨ but the orderlies violated her every time they assaulted her.  Nobody will ever know the things that happened in the jail cell.  Since the sexual violation of women is illegal in most of the world, and has serious psychological consequences, how did this female psychiatrist fail to comprehend this?  This patient has clearly established that she was a celibate [xviii]Roman Catholic at the time.  By contrast, the doctor who gave gynecological exams honored the patients modesty at all times[xix]

 Chemically restraining the patient with Haldol in a jail cell, clearly did not improve the patients condition.  Dr. Lee reports the patient screamed until she was hoarse on Haldol, but continued with persecution and" litiginous "themes.  [xx] This patient is convinced that any time she is confined to a jail cell, where she is tortured, abused, sexually violated, and forced to take dangerous drugs against her will, the response would be the same.  This is why this treatment is strictly forbidden by the Geneva Convention for prisoners of war, and violates the rulings of the Supreme Court.

 Since Dr. Lee was never going to change this patients, accurate assessment of abuse, adding another civil rights violation to the other atrocities was not the correct treatment decision.  Perhaps if there had been a veterinarian present, he would have tranquilized the patient.

Pt called sister to complain she been given meds against her will last night.  but saw no record of this in the med charts.

One of the strangest aspects of this perverse clinical environment, was the general pretense that patients could refuse medication in prison.  Support staff swarmed like flies around this patient.  The only reason this patient ever took medicine, or even pretended she would, was fear of further abuse or exhaustion from coercion.  The patients intentions were clearly stated every day:

1.      Drugs made her crazy.

2.      The hospital was violating her civil rights.

3.      She would stop taking medication as soon as she left the hospital.

4.      The staff punished her in a jail cell as behavior modification.

Nevertheless, the staff made a ritual of signing consent forms.  Initially, this patient simply tried to refuse signing.  In retrospect, the forms were illegal, because none of them reflected genuine Food and Drug labels.  No educated patient would consent to the combined side effects listed on the hospital forms, because they essentially guarantee debilitation.  The forms  fail to reveal dangerous adverse reactions.  The official  Haldol forms state that tardive dykinesia takes three weeks, when every doctor knows it takes a single dose.  The doctors tried to lie to licensed teacher.

 Dr. Lees notes provide some interesting examples of secret medication side effects:

1.      On August 21,1998 an LSCW notes this patients medication levels ranged from subtherapeutic to toxic.  [xxi] Dr. Lee notes she withheld medication that morning due to orthostatic hypotension.[xxii]  This certainly was not on the consent form, and no patient consents to toxic levels of medication.

2.      On September 2, 1998, Dr. Lee notes the patient questioned whether Depakote is implicated in her insomnia.[xxiii]  Abbot Laboratories lists it as a side effect,[xxiv] along with Olanzepine.[xxv]  The patient clearly, and accurately recognized a side effect, and the psychiatrist simply lied about it.  This patient had severe insomnia almost every day, and the psychiatrist was consulting a pharmacist to treat it.[xxvi]

Being Overmedicated

The Consensus Guidelines for the Treatment of Bipolar Disorder provide algorithms for responsible medication.  It is impossible to ascertain what Dr. Lee was doing.  There has never been a clinical study confirming the safety and efficacy of this medication pattern.  The exact physiological effects of drugs this powerful, in combination, are unknown and unpredictable in any individual patient.  This psychiatrist endangered this patient with death and permanent disfigurement every day in confinement.  This patient was so debilitated with tremor that when she left the hospital, she was incapable of signing a legible check.[xxvii]

Dr. Lee seems to devalue menstrual symptoms at all times, as well as the powerful hormones that were prescribed simultaneously.

Depakote

The patient allegedly entered the hospital for a manic episode, and lithium remains the safest most effective medication to treat a manic episode.  [xxviii]Since the patient had no choice, why was she not forced to take the safest medication.?

1.      Dr. Lansky makes it perfectly clear that this patient was less sedated and more manic at therapeutic level of  110.¨

2.      The Food and Drug Administration label notes that Depakote has very serious side effects, tardive dykinesia, and that its safety and efficacy cannot be assured for more than three weeks.

3.      This patient took Depakote for the first time on 8/ 4 [xxix]and by 8/7 she was already sick.  Dr. Nygren instructed her to d/c all medication[xxx].

4.      Dr. Hoffmans [xxxi]laboratory reports are highly informative.

a.      By August 12, in one day, the patient was forced into a therapeutic level of 109.3 and was restrained.

b.     By August 13, the patient was locked in a jail cell, forced to a level of 133, and then forced to take Haldol.

c.     By August 20, at level 78 the patient was sleeping a great deal.

d.     This report supports this patients, repeated claim, that medication makes her manic, and that it is not a spontaneous state induced by her own physiology.

e.      This report suggests the patient was abused and violated for symptoms induced by forced overmedication., rather than the patients alleged mental disorder.

5.      The social worker who observed the patient on August 21, 1998 noted that the morning meds were withheld this patient had no symptoms of mania or psychosis.[xxxii]

6.      On August 27,1998 Dr. Lee finally granted the patient her Fourteenth Amendment Rights.  This patient refused medication from every nurse willing to accept the Supreme Court, and at least one nurse was ethical.[xxxiii]  These marked changes are evident in a week:

a.      On September 1, 1998, Dr. Lee fails to report this patient is manic.

b.     Almost every day Dr. Lee reports this patient is disheveled, half-disrobed, requiring continued staff redirection to dress more appropriately.  This suddenly stops happening when the patient refuses medication.

Glasses: Extra pair to be sought from lost and found today

a.      At many levels, this was the most abusive medical treatment of all, and a primary reason this patient had contempt for the medical staff.

b.     This patient was born with very seriously crossed eyes.  She required contact lenses or bifocals just to function and prescription reading glasses.[xxxiv]

c.      When the staff restrained the patient, they forced her to remain in a position with fluorescent lights shining directly in her eye, which makes it impossible to sleep.  She was unable to clean or remove her contact lenses, so the irritation was unbearable.

d.     When this prisoner was released from the jail cell on Haldol, she was incapacitated by tremor, and lost her hand eye coordination.  The contact lenses were lost and never replaced.

e.      All the medications the patient was forced to take had side effects related to eyes.

f.       The patient broke her bifocals, trying to wash her clothes with impaired vision.  [xxxv] Rather than consulting an ophthalmologist who may have provided a competent solution, Dr. Lee just ignored the patients visual impairment.

g.      Dr. Lansky treated congenital crossed eyes from the lost and found, and notes the patients poor judgment.

Being held against her will

a.      Clearly this patient was.  The particularly heinous part of this is that she was provided with a paper notifying her that she would be provided with a lawyer in 72 hours.

b.     This patient was never provided a lawyer, because she was locked in a jail cell, tortured, abused, and sexually violated and then forced to take Haldol.  Dr Lee reports she confined this patient for agitation, which is a side effect of many of the drugs this patient was forced to take, and a normal response to an abusive prison environment.

c.      Dr. Lansky notes on August 12, 1998 that patients 5150 ends Friday at 1500.[xxxvi]  On Friday August 14, at 1040, she already notes the patients status had already changed to 5250.[xxxvii]

d.     In other words, the patient was locked in a jail cell without the benefit of due process, and without access to a lawyer after 72 hours.  The patient was so overmedicated after 72 hours that she was unable to speak[xxxviii]

©Lawyers meet prisoners in jail cells on a regular basis.  No lawyer ever entered that jail cell, announcing  he would represent this patient.  Every class of medical employee writes the patient threatened a lawsuit.  Why was this not a patient demanding her right to a lawyer  in a jail cell?  Why was a lawyer never provided?  Did Dr. Lee think that it would calm the patient to know, she was never going to see a lawyer?

 The difference between a medical hearing, and a legal one is evidence.  That is why the Supreme Court is so specific, that only a court can confine a patient, not a doctors opinion.  All the evidence in this case was readily available by a simple phone call at the time.  A lawyer may have reached an independent decision about civil rights in a jail cell, and forced medication.  Those consent forms the patient refused to sign were available for examination, by a lawyer at the time.

©  Dr. Lee concludes page one of her perjury that patient was too labile, paranoid, anxious and easily upset to be able to accept treatment voluntarily.  Rather than paranoid, the patient had evidence-based opinions that she was in an abusive environment, where forced medication was making her much worse every day.

Bipolar Affective Disorder

Harvard scholars dominate the field of BAD research in virtually every area.  Dr. Hagop Akiskal has essentially revolutionized thinking about this disease with his Spectrum of Bipolarity theory.  The following excerpt is an from his keynote address in Chicago in 1996: [xxxix]

The classification of bipolar spectrum conditions represents an evolving scenario that has not led to a universally accepted schema.  Suffice it to say that bipolar I (mania) and bipolar II (hypomania) are now part of the official psychiatric classification in DSM-IV.  Nonetheless, beyond the classic boundaries of manic-depression, types I-VI have been proposed.

Suffice it to say the patient repeatedly reported a history of drug induced manic episodes, and  that she had a propensity toward Bipolar, [xl]but was not.  The patient was fully aware that she may fall within the range of an affective order, but was never Bipolar I and never stabilized on daily medication.  Not only do Dr. Lees records prove this, but this patient has never taken a mood stabilizer since this system forced her to take it.  Drug induced mania is medically recognized as a very separate phenomenon.

 Dr. Obaray, her family doctor, has treated her successfully with only intermittent low doses of Paxil and Dalmane.[xli] He provided this patients essential medical exam for employment.  Dr. Lansky reports the patient was diagnosed with BAD in 1987, but there was never credible evidence of this.  BAD is a degenerative incurable brain disease.  It is difficult to explain how a Type I patient was only treated with a mood stabilizer  in her entire life for  a month in 1998 that made her more manic and much worse.  How does Dr. Lee explain her own diagnosis and treatment plan in view of this evidence?  Why was this patient confined to gain insight that she needed daily medication, when it was never true?  The patient repeatedly said that medication made her manic, and the clinical assessments reflect this.

Due to mental disorder inability to provide for shelter

Dr. Lee already lied to the court that the patient lived on Ashbury St, so why was this question even relevant?

The patient has already documented that she lived at the Casa Loma without a problem before and after hospitalization.  The connection between labile, paranoia, anxiety and easily upset with staying at this hotel are unclear.  What are all the hotels this patient, allegedly, was asked to leave for disruptive behavior?  These doctors truly invented lies.

This report seems to reflect Dr. Lees false belief the patient was an indigent, with some kind of bad reputation which nobody can ever substantiate.  The patients actual residences have been documented in other chapters.

Current Medications

Supreme Court Justice Kennedy has a profound distrust of psychotropic drugs.  When he made his landmark decision about the right to refuse medication, he was very clear that, the court, should inquire about all aspects of the side effects of the proposed drugs.  Dr. Lee lied that the patient was taking three drugs, because Dr. Lansky listed them all.¨  The significance of this is that the patient was severely overmedicated, and had Dr. Lee used all the lines to list all the drugs, this would have been evident.

Locked facility

The Supreme Court ruled that patients cannot be confined without proof, beyond reasonable doubt, they are a danger to themselves or other people.  Irritable, anxious, and labile does not meet that requirement.  In view of the evidence,  it is hard to prove this patient was paranoid when she was obviously locked in a jail cell where she was abused, sexually violated, and forced to take drugs that clearly made her manic.

Service plan

Dr. Lees plan made this patient much worse, and she intended to continue to this torture for an extended period, with no regard for the patients genuine welfare.  A content analysis of her notes will show that she had a computer template and  simply reordered the same sentences in every report,, with occasional new items.  Since she left the ward by 4 pm, she had no idea what happened at night when the doctors were gone.

One thing is certain, she noted the patient had severe insomnia almost every night.  The ward shut down every night at 10:00 pm.  The lounge was off limits, and TV, radio, and phone calls were all forbidden.  The patients glasses were gone so she could not read.  Patients were forbidden to get their own cold beverages with horribly dehydrating medication.  The staff forced her to sit on the floor every night outside her room.  The patient still has no insight into this abuse.  The National institute of Mental Health has determined that darkness calms mania.  This patient was forced to relax in broad daylight, or with fluorescent light in her eyes.

Much Worse: Full Dehumanization

It is useful to examine this patients initial clinical assessments, before she was forced to bring her Depakote level to 133.[xlii]

Pleasant.  Reading seven magazines. Asked to read the PDR. Reclining on the bed in a stylish dress. Says she was having drinks at the Ramada Inn, and its like a One Flew Over the Cuckoos Nest Experience. Princess-like

This patient was indeed at the Ramada Inn[xliii], and the Travelodge[xliv]. The hospital staff never restored this patient to this peaceful original state before medication This was the Cuckoos Nest Experience. This patient was a licensed professional, with education beyond her Masters, with a potential income of  $1500 ,living at the Casa Loma in search of another apartment. This patient had a history of drug induced manic episodes, from medications, known to induce manic episodes. Hours later she was locked in a jail cell, forcefully medicated, tortured, abused and sexually violated without ever speaking to a lawyer. Dr. Lee was treating this patient with a potion of life threatening medicine to convince her ,that she was an indigent Bipolar I patient who needed tardive dykinesia to make safe decisions about shelter.

Dr. Lee writes  this about the patient on August 28

becomes more irritable and exasperated about being discriminated against and maltreated when she feels her problems are being pointed out to her-and it appears too painful for her to acknowledge her current problems.

Dr. Lees problems have been pointed out to her. This patient hopes it will not be too painful for Dr. Lee to acknowledge them in writing.