Cuckoo's Nest Revisited

SEC. 97-3-13.  False confinement; sending sane person to insane asylum.

Every person or officer who shall maliciously send to or confine in an asylum, mad-house, or other place, any sane person as a lunatic or insane person, knowing such person to be sane, shall be guilty of a felony, and, on conviction, shall be punished by a fine of not more than five hundred dollars, or by imprisonment in the penitentiary not more than one year, or in the county jail not more than six months.

MISSISSIPPI CODE OF 1972

Psycho Social Medicine

False Confinement as a Treatment Decision

Dr. Mark Sexton, Psychologist

Dr. Kristen Nygren, Psychiatrist

Statement of Purpose

The purpose of this paper is to prove beyond reasonable doubt that Dr. Mark Sexton and Dr. Kristen Nygren were negligent, and that their treatment decisions resulted in this patient's permanent harm.  This is a formal Community Mental Health Grievance.

Background

This patient entered treatment with Mark Sexton on November 20, 1998.  On August 11, 1998, he advised her to voluntarily enter San Francisco General Hospital.  Without informing her, he filed a 5150 [1]against her.  As the result, this patient was falsely imprisoned, tortured, and abused for 23 days without the benefit of a lawyer.  In May 2001, she was referred to both, The Center for Special Problems,[2] and California Pacific Medical Center for treatment for trauma, and remains disabled today with Post Traumatic Stress Disorder.

Overview of Diagnosis and Treatment

The patient had reality-based insight into her own psychosocial, and medical condition at all times.  This paper presents original evidence, which was always available at that time.  Nevertheless, Dr. Sexton fabricated information in his records, which served as the basis for her reality testing at all times.  She was assessed as mentally ill, for accurately reporting factual evidence, which was incongruent with the fabrications in her Psycho Social Medical Records.

An examination of his initial consultation report to the Haight Ashbury Free Clinic provides the key to his negligence.  [3] This patient entered treatment to continue her professional career.  In his final summary on 9/15, he states this patient was "much worse" [4]after his treatment decisions, and terminated her case.

 This patient accurately reported that she had a dangerous and unreliable response to medication to all providers.  Dr. Sexton still advised her, constantly, to seek medication from licensed physicians, based upon his unidentifiable treatment plan.  He sent her to Dr. Anderson to get medication, immediately, and cut therapy sessions short to send to her to Dr. Nygren.  There is not a single signed consent form indicating this patient was advised of adverse reactions.  This paper will prove this patient, voluntarily entered the hospital, because she realized that she was disabled by prescription drug side effects

Negligent Psycho Social History

She was falsely confined for twenty-three days, because the doctors told the staff that she was a homeless, indigent bipolar patient who responded to Depakote, but was noncompliant, when genuine evidence proves this was never true.

False Income

Social Security Records show this patient had a monthly SSA income of $975 per month directly deposited into her Well' s Fargo account[5] that was opened in 1993 and provided a credit line of $200.  SSA benefits included the standard option to earn $500 per month in 1998. 

False Housing

1.      The patient described her own status as "in transition" between apartments,[6] because she always had the income to rent an appropriate apartment room.

2.     This patient was living on 17th Street when she entered treatment,[7] and resided at that address until she lost her case against the landlord and moved out in April.[8]   She had a telephone in her own name.*

3.      Dr. Sexton confirms this patient's residency in his notes on 4/22.[9]

4.    When this patient was tortured in a hospital jail cell, a social worker reports Dr. Sexton falsely said this patient was homeless[10] for six to nine months

False Psychiatric History

1.     This patient accurately reported that she had two "drug induced" manic episodes associated with Demoral in 1987, and Xanax in 1989.[11]  Dr. Felix Delvecchio, her childhood psychologist in New Jersey, personally observed her manic episodes to confirm this.

2.      Dr. Sexton reports she had two spontaneous manic episodes[12] and a diagnosis and treatment history of manic-depressive illness[13] without personally validating this.  By 1998, DSMV IV made it quite clear that drug induced manic episodes are a separate phenomenon from Bipolar Affective Disorder.

3.      This patient was only hospitalized overnight in both 1987 and 1989 and never "stabilized on medication".  Neither doctor called the hospitals that would have validated this.  Now it is impossible to do so.[14]

4.      Dr. Nygren records this as "psychiatric hospitalizations" with the implication this patient had a history of successful treatment with a mood stabilizer, or a previous involuntary hospitalization.  She invents a third overnight hospitalization for suicide in 1990.[15]

5.      This patient was already receiving disability payments for another condition, and told Dr. Fenton[16] that she preferred to return to work.

6.      Dr Sexton falsely records this patient came to him to acquire disability *even though he mentions Dr. Fenton in his notes.

False Medication History.

1.      Dr Sexton reports this patient began taking Depakote on 8/4 and her speech was slurred.[17]

2.     Dr. Nygren called this patient at the Ramada Inn and told her to d/c all medication on 8/7 [18]when patient reported negative side effects.

3.      When this patient was tortured in a jail cell, Dr. Sexton falsely reported that she responded to Depakote* when evidence indicates it was discontinued within a week for side effects.

4.      Months later he falsely reports a positive response to Depakote[19] to the social worker treating this patient after her trauma.

5.     There is no record of this patient responding positively to medication in three days, or 23 days, because she was "much better" before she took medication.

On the legal 5150 Dr. Sexton reports this patient was "recently homeless."

1.      This patient lived at the Casa Loma before *and after her false imprisonment, as evidenced by her California State ID[20]mailed to her at that address.

2.      Dr. Sexton provided a note[21] on 7/9 that was on file with Raja, the hotel proprietor.  There are still witnesses to verify this patient's residency.

3.    In the week before her false imprisonment she was staying with fiends at both the Travelodge[22] and the Ramada Inn,[23] and accurately reported this to Dr. Sexton, Dr. Nygren and the hospital staff

Diagnostic Problems

Substance Induced Mood Disorder

1.      DSMV IV- provides the window of a month for a manic episode as the direct result of intoxication or withdrawal from anti-depressants.

2.     This patient was repeatedly advised to take medication, and was prescribed polytherapy with various anti-depressants: Adivan, Dalmane, Paxil, Restoril, and Trazedone from 1/13[24] to 7/22 [25]with two refills.

3.     The actual hospital consent forms for Ativan, Restoril, and Dalmane clearly state these drugs are addictive.

4.     The Food and Drug Administration labels for all three describe mania as a side effect.  Paxil is associated with special problems including a special precaution about patients with a history of mania.

5.     Hormone therapy began concomitantly with anti depressant therapy, and these drugs have well documented mood side effects.

6.      Harvard explains the symptoms the doctors induced with their reckless medication pattern:

The symptoms of SSRI discontinuation (which are also precipitated by the discontinuation of clomipramine, a tricyclic drug with strong effects on serotonin) may include dizziness, trouble with balance or coordination, headaches, nausea, fatigue or lethargy, tingling, electric shocklike sensations, insomnia, and vivid dreams.  Less common reactions are gastrointestinal discomfort and flu-like symptoms.  Sometimes there are also mood changes irritability, sadness, anxiety, agitation, and crying spells.

Reckless Rapid Cycling Anti-depressant Prescriptions

1.      Without a treatment plan explaining the goal, Dr. Sexton insists this patient begin medication under the direction of a novice intern, Dr, Anderson.

2.      After this patient reports incompetent medication in the past, and a manic episode from Xanax, Dr. Anderson accommodates Dr. Sexton by prescribing five new drugs for his patient all at once: Paxil, Adivan, Dalmane, and two hormone medications.

3.      On 5/19 the pharmacy made a dispensing error[26] which was resolved on 5/ 22 [27]with a return appointment scheduled for 6/23.  This patient was scheduled for three days of discontinuation syndrome.

4.      On 6/23, this patient was vomiting in Petaluma.[28]

5.      On 7/9, Dr. Nygren fails to recognize discontinuation syndrome, and the special withdrawal problems with Paxil, and refuses to believe this patient became ill in Petaluma.[29]

6.      On 7/22, the next novice intern renews the prescriptions.[30]

7.      On 7/23, Dr. Nygren notes this patient is calm on that regimen.[31]

8.      On 8/4, this patient becomes immediately sick after complying with coercion to take Depakote.

9.      On 8/7, Dr. Nygren advises the patient to d/c all medication, and plans to place her in the hospital so the staff could force her to get sick.

10.  On 8/11, this patient's future was permanently destroyed at Dr. Nygren's discretion at 3:30 pm, when the patient claimed she was sick from medication side effects.*

Bipolar Affective Disorder

The American Psychiatric Association's Guidelines for the Treatment of Bipolar Disorder note that this diagnosis is to be reserved for spontaneous mania, which is not associated with the side effects of a drug.  They specially note that anti-depressant" manic like" episodes are not to be included in this disease.

Adapted from DSM-IV-TR; manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, ECT, light therapy) should not count toward a diagnosis of bipolar I disorder.

Adapted from DSM-IV-TR hypomanic; -like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, ECT, light therapy) should not count toward a diagnosis of bipolar II disorder.

1.      In summary Dr. Sexton, reports Polysubstance Dependency* with the quote, which confirms this patient's symptoms, were substance related and not spontaneous.  "Pt. evidenced increase manic behavior and disorganization secondary to substance use."

2.      Like all mental patients, this one was scrupulously honest about her drug experimentation, but the substance that made her manic in this period was prescribed by doctors.  This patient was never in treatment for substance abuse, and it never impaired her ability to lead a productive life in the decade before treatment.  Proposition 215 defines medical benefits, which are not known to induce manic episodes.

3.     Despite these reference sources, both doctors conclude this patient's symptoms are not "manic like" but Bipolar II Rapid Cycling.

Biased Clinical Assessments,

"Grandiose and delusional" This patient's full verifiable resume at the time is included, which shaped her presentation at all times.  [32] This patient was assessed as delusional, because she failed to ever present herself as a homeless indigent.  This patient never aggrandized herself beyond her documented achievement

Menstrual Symptoms were this patient's main complaint in the first session, *and she reported they disabled her for at least ten days a month.  The role of these symptoms was devalued at all times.  m* This patient's menses can be charted from the hospital report of her requiring a heating pad for cramps.  Depakote causes menstrual cramps.

 This patient's  true individual psychological history were never addressed.

1.      Dr. Sexton reports that he severed her relationship with her original therapist Rachael Cunningham.[33]  While teaching in 1993, this patient was assaulted outside her apartment on Page Street, and became too frightened to commute to work.  She was treated at Kaiser Permanente for a black eye.[34] Dr. Alan Cooper treated her psychologically for this incident, and later referred her to Rachael.[35] If this patient had kept her relationship with a woman, her menstrual systems may have been received credence, and her genuine history of trauma might have been addressed.

2.     The landlord at the artist's coop on 17^th Street was so violent that the police were frequently called to the apartment.  R This patient noted all this in the court case, and it served as a major source of fear and anxiety.

Negligent Treatment Decisions

Therapy

1.      This patient entered therapy with a Psychologist to deal with psychological issues.  By focusing on anti-depressant induced manic episodes from an earlier decade, this doctor neglected this patient's authentic problems.

2.      Since the patient voluntarily entered the hospital with the doctors' persuasion, it was cruel abandonment to sever the therapeutic alliance and send a patient "much worse" to a new therapist to begin all over again.

Medication

1.      Since the patient reported a dangerous unreliable response to medication, it was irresponsible to immediately suggest new medications instead of observing her in a drug free state.

2.     If the patient were bipolar, she never should have been prescribed Paxil and three other anti-depressants at once.  They should have all been gradually tapered, before she was addicted.  Mood stabilizers are not a proven treatment for drug induced manic episodes.  Avoiding excessive medication that induces mania is.

Depakote

1.      The Food and Drug Administration label indicates horrendous side effects, including tardive dykinesia,[36] and that its safety and efficacy cannot be assured for more than three weeks.

2.     Most specifically, it exacerbated pre-existing medical conditions by increasing menstrual cramps, and causing eye pain.  There was no behavior severe enough to require a medication this dangerous.

3.     The Abbot Laboratories' advertisement states that it is only effective for 58% of genuine Bipolar I patients.[37]

4.      Since both doctors diagnosed this patient as Bipolar II, there has never a clinical study of this drug with this population, and lithium remains the safest and most effective treatment for a manic episode.

5.      This patient reported that Lithium made her " more manic",* and the intern confirmed the patient was "more manic" at therapeutic levels of Depakote.  * Her notes also document the abuse the patient suffered, because these doctors falsely believed the patient should stabilize on this drug.  This confirms the patient's repeat report of a paradoxical response to mood stabilizers, which contraindicates BAD.

6.      Dr. Nygren's admission,[38] that she personally cannot monitor a Bipolar II patient with a Master's Degree, without "stabilizing" her on this medication is testimony to her own competence.  She should have understood the phenomenon of drug induced manic episodes, and treated the patient on that basis, before she destroyed the patients life with a 5150.

7.      Both these doctors made the decision that this patient must be forced to take Depakote, when there was no credible medical evidence to support it.

8.     The records clearly show this patient only took this drug four days, and the doctors told her to discontinue it.  They absolutely lied to other professionals that this patient "responded" to it.

False Imprisonment

1.      The question to be examined is not, whether this patient suffers from an affective disorder.  The question is whether the doctors had the right to deny her informed consent, and convict her to a lunatic asylum.  If their diagnostic and treatments decisions had been correct and successful, none of these issues would matter.  Instead this patient was locked in a prison, tortured, abused and overmedicated for 23 days, and still has nightmares about it, five years later.

2.      This patient never had a criminal record.[39]  There is no evidence to suggest she was a danger to herself or anyone else.  The Grave Disability was medical side effects.  Mild hypomania from Proposition 215 or Bipolar Disorder is not a criminal offence that deserved a psychiatric prison sentence.  More importantly, they never led to hospitalization, before the patient was coerced to comply with dangerous psychotropic drugs known to induce mania.

3.      These doctors sent this patient to a madhouse for apprehension about a dangerous drug, which the hospital confirmed, made her manic, without ever presenting her with a consent form disclosing the medication's "common" side effects.

4.     Dr. Wolk d/c this medication officially on 11/23 when this patient's hair fell out.[40]

Descent into Hell on August 11, 1998

1.      Dr. Nygren told this patient to d/c all medication on August 7, while the patient was staying with friends at the Ramada Inn.

2.      She informed this patient that she must keep her appointment on August 11 @1pm.

3.      Patient arrived on time, and doctors convinced her to enter the hospital.

4.      Patient called her sister in New Jersey and her husband in Rhode Island from the conference room at the end of the hall.R

5.      Patient took a cab to get her luggage, and pay her storage bill.[41]

6.      Dr. Sexton carried her luggage to the back door.

7.     This patient's first assessment on Ward 7A was in the nurse notes: Pleasant.  Reading seven magazines.  Asked to read the PDR[42]

Within 24 hours of hospital prison care:

1.      Pt appears disheveled and very upset

2.     Attitude is angry, indignant, and humiliated

3.     Patient demanded food, clothes, and phone.

4.     Thought content focused on the hospital being cruel and unethical

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

Dr. Sexton and Dr. Nygren are a disgrace to their profession, and heinously disregarded the rulings of the Supreme Court.  As city employees in the social welfare system, they are absolved from any responsibility for their actions which caused this patient to remain permanently "much worse" as the innocent victim of their negligent treatment.